Affiliated with The University of TexasHealth Science Center at Houston

(UTHealth) Medical School

PROUD TO BE NURSE FRIENDLY!The mission of nursing at the Memorial Hermann-Texas Medical Center Campus is to drive quality outcomes by protecting, promoting and optimizing the health and wellbeing of patients we treat.

November 15, 2012

a publication for nurses and allied healthcare professionals

Memorial Hermann-TMC embraces Magnet’s® New Knowledge, Innovations, and Improvements component by using evidence-basedpractice and research to reduce the incidence of falls. The pediatric intensive care unit (PICU) at Children’s Memorial Hermann

Hospital leads the Campus with zero falls for the past 789 days. PICU patient Kyera Wells wears the red socks, which indicate fallpatients, and plays sock puppets with PICU nurse Payal Divecha, R.N., and Child Life intern Stacey Lacombe.

Magnet® organizations have an ethical responsibility tocontribute to patient care, the organization and the professionin terms of new knowledge, innovations and improvements.They conscientiously integrate evidence-based practice andresearch into clinical and operational processes andencourage nurses to design and implement clinical projectsthat improve nurse-sensitive and patient outcome indicators.In addition, they encourage nurses to provide input into policyand procedure development and new programimplementation.

Examples of New Knowledge, Innovations andImprovements are:• A Nursing Shared Governance Council dedicated to

nursing research and empowering nurses at all levels toactively participate in research and evidence-basedpractice activities

• Development of fall prevention strategies• Nurse-led education fairs to explore safest and best

practices for patients and the environment, and togenerate new knowledge

– American Nurses Credentialing Center

Improving Best Practices and Reducing Falls

What Is New Knowledge, Innovations and Improvements?

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One example of Memorial Hermann-Texas Medical Center nurses embracingMagnet’s New Knowledge, Innovationsand Improvements component is theCampuswide focus on improving nurse-sensitive indicators, such as patientfalls. By analyzing unit data throughcomparison to benchmarks andreviewing events for themes and trends,the nurse-led falls task force establishedbest practices, which has significantlyreduced the incidence of falls over thepast fiscal year.

Virginia Earley, R.N., director ofnursing quality integration and falls taskforce mentor said, “As a result of thetask force’s work, we have greatlyreduced falls, and their evidence-basedbest practices have led to outstandingpatient outcomes.”

Earley analyzes the fall rates eachmonth and passes out Fall ReductionStars to units who have made great

strides in quality by focusing their effortson achieving zero falls for a period oftime.

Congratulations to the followingdepartments for raising the bar andmaintaining excellent, quality patientcare. September’s Fall Reduction Starsinclude:Children’s Memorial Hermann Hospital• The 50 Club

• CSC – 60 days• The 100 Club

• Labor and Delivery – 146 days • Family Life Center – 190 days

• The 400 Club• Pedi PACU – 352 days

• The 800 Club• PICU – 789 days

Memorial Hermann-TMC• The 50 Club

• NTICU – 51 days• Signature Suites – 53 days• NIMU – 58 days• CIMU – 61 days

• Burn Unit – 62 days• CVIMU – 63 days• 5 West Cullen – 76 days • STICU – 80 days

• The 100 Club• TCF – 111 days• Radiology – 143 days• CVICU – 151 days• TSICU – 185 days• MIMU – 190 days

• The 200 Club• Preoperative Holding – 207

days• Procedure Area – 259 days• MRI – 260 days• COU – 272 days• Hemodialysis – 273 days

• The 400 Club• Cancer Center – 445 days• MICU – 475 days

• The 500 Club• Day Surgery – 555 days

Global Issues in Nursing & HealthcareStructural

Empowerment

TransformationalLeadership

ExemplaryProfessional

Practice

NewKnowledge,

Innovations &Improvments

EmpiricalOutcomes

Leading The Way in Nursing Discovery Through the Professional NursingResearch and Evidence-Based Practice Council

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For decades, research has shown thatquality outcomes are linked to bedsidenurses being empowered to makedecisions that directly affect patientcare. At Memorial Hermann-TexasMedical Center, one of the ways nursescan directly impact patient care is byparticipating in the ProfessionalNursing Research and Evidence-BasedPractice Council, part of the NursingShared Governance Structure.

The Council works to strengthenthe abilities of the clinical nurse toreview, interpret and implementresearch to enhance professionalnursing practice across the hospital’sservice lines.

Council Chair Danielle Salley, R.N.,says, “The Council empowers nurses byproviding them the opportunity to makea difference in their practice and directlyimpact patient care on their unit.”

It’s proven that the most efficientand effective processes of care are drivenby caregivers and backed by evidence.Nurses must remember to ask the toughquestion – is the care I’m providingevidence based?

Salley continues, “Our goal is not todo the research, but to guide and mentorpeople through the research process.”

For example, the Council previouslyworked on a study aimed to helpminimize sacral pressure ulcers in theadult cardiac population. A nurse-ledinitiative, the project started whensomeone asked what could be doneabout skin breakdown for patients whohave prolonged OR times and strictmovement requirements thereafter.The Council’s findings helped improveboth quality care and patient outcomes.

Co-chair of the Council CandaceScheresky, R.N., says, “As professionalnurses and an organization striving forMagnet® status, we must takeresponsibility for how care is provided toour patients. If we want to be the best,we must provide the best care andconsequently, the best care leads totremendous patient outcomes.”

If you are interested in joining theCouncil or have questions or ideas thatyou would like to be researched, pleasecontact Salley at Danielle.Salley@memorialhermann.org.

Member of the NICU’s Family-CenteredCare Committee, Ashley Heaton, R.N.,B.S.N., neonatal intensive care unit(NICU), recently presented her researchproject at two national conferences,including the Vermont Oxford Network(VON) and the National Association ofNeonatal Nurses (NANN), earlier thismonth.

Her project idea originated whenshe noted an opportunity for improvementin the NICU’s care delivery process in

regards to continuity of care for their patients and families. Heaton explains, “At 118 beds, the NICU requires a robust staff to

care for that many patients each day. And due to the large staff number,continuity of care is always a challenge. The Council gave me the supportI needed to get this project off the ground.”

The project titled, “Continuity of Care: Designing an Innovative NICUNursing Care Delivery Model,” was aimed at improving the continuity ofcare by developing and implementing a nursing care delivery model thataddressed the complex NICU environment. The goal was to demonstratea 25 percent improvement in the Continuity of Care Index (CCI) by theend of the summer 2012 pilot. CCI is defined as the total number ofnurses caring for an individual patient divided by length of stay multipliedby two shifts per day.

Results proved that the team nursing care delivery model decreasedCCI by over 25 percent for patients in the pilot pod. Also by utilizing thismodel, Heaton defined a small group of nurses to regularly staff in thesame pod so they could become familiar with that group of patients. Thishas led to improved patient and nursing satisfaction as well as improvedinterdisciplinary communication, collaboration and teamwork.

Pictured above are a few members from the Professional NursingResearch and Evidence-Based Practice Council.

For the first time in their 46 years ofmarriage, Frances Ridenour knew shecouldn’t get her husband, Larry, what hewanted most for his birthday. It was agift that he had never asked for before,but needed this year. Larry's birthdaywish was for the gift of life.

On the morning of September 20,Larry woke Frances up complaining ofserious chest pains. She called 911 andhe was rushed to a local Texas Cityhospital where he suffered a heartattack. The physicians knew he was incritical condition and that his heartneeded immediate assistance.Therefore, they decided to insert anintra-aortic balloon pump through hisfemoral artery and into the heart.

No stranger to heart conditions,Larry had a history of heart disease andpreviously had an angiogram and triplebypass. At the hospital, he wasdiagnosed with end-stage heart failure –a condition so severe that all treatments,other than a heart transplant, wouldmost likely fail. Larry needed to betransferred to a facility that could offer a

higher level of care, so the hospitalcalled the Center for Advanced HeartFailure at Memorial Hermann Heart &Vascular Institute–Texas MedicalCenter.

Larry was transported by LifeFlight® and immediately assessed by theCenter’s team, which is led by IgorGregoric, M.D., chief, Surgical divisionand Biswajit Kar, M.D., chief, Medicaldivision. Pranav Loyalka, M.D., servesas the associate chief, Medical divisionand Sriram S. Nathan, M.D., is thedirector of Cardiogenic Shock.Kumudha Ramassubbu, M.D., Medicaldivision, and Manish Patel, M.D.,Surgical division, also helped tocoordinate his care.

“When you come to the Center forAdvanced Heart Failure, you won’t beseen by just one doctor,” said Dr. Kar.“You will be cared for by an entire teamof specialists from the Medical andSurgical division physicians to the hearttransplant and ventricular assist device(VAD) coordinators. It requirescollaboration across multiple disciplines

to produce the best possible outcomesfor our patients.”

Shortly after arriving to thehospital, Larry was moved to thecardiovascular intensive care unit anddesignated as a candidate for a hearttransplant. In the meantime, Larrywaited in bed, having to keep one legcompletely straight to avoid bending thepump’s catheter. Frances elaborated,

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A Life-Saving Birthday Gift – Man is First to Receive Heart Transplant at Center for Advanced Heart Failure

Our Campus is proud to announce Stephanie Cochran, R.N.,Children’s Center North, as October’s recipient of the DAISYAward, which recognizes one nurse each month for goingabove and beyond to deliver exceptional patient care.

“I’m incredibly honored to receive this award and trulyhumbled that a patient’s family member took the time torecognize me,” said Cochran. “My goal is to do everythingpossible to care for these kids and their families. I love what I do!”

The nominator, a patient’s mother, wrote, “Stephanie isupbeat and positive. She explains procedures in the way thechild understands. She supports the doctors, nurses andparents to help coordinate the best plan of care for the patient.She listens and connects with the family and the patient. Shestays over to ensure the report is given and all medical recordsare up-to-date. She also does this to make sure the incomingnurse is prepared for the patient before she leaves.”

The patient’s mother also took the time to explain howCochran meets each pillar of the Nursing Professional PracticeModel. She explains, “Stephanie is a clinician because sheshows empathy. She is a collaborator because she has a teamapproach and applies the care plans of others. She is anadvocate because she encourages family members to not stop,but to continue when things get hard. She is an innovatorbecause she thinks ahead and works for optimal outcomes.

She is a teacher because she explains, demonstrates andensures the patient and family is comfortable with theprocedure. She is a leader by example and helps others whenneeded.”

The designation, presented in collaboration with TheAmerican Organization of Nurse Executives, is part of theDAISY Foundation’s national program to recognize nurseswho serve as role models to colleagues throughout theprofession.

To nominate a nurse for this prestigious honor, fill out anomination form located on various units throughout thehospital and available online at TMC Connections on InSite.Nominations are due by the 15th of each month, or they will becounted as a contender for the next month’s award.

October’s DAISY Award Goes to… Stephanie Cochran!

Larry Ridenour,pictured withwife Frances,thanks theCenter’scaregiver teamfor helping tomake his 70thbirthday wisha reality.

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Continuing our journey toward Magnetstatus, the Memorial Hermann-TexasMedical Center Campus exemplifies elementsof the Magnet program in the daily activities,behaviors, attitudes and professionalism ofthe nursing staff. To capture these elements,Magnet Moments provides caregiver storiesthat demonstrate the passion and driveevident in Magnet hospitals. This columnrecognizes our Campus caregivers’ knowledgeand technical skill with the artistic,immeasurable elements of caring, humanityand compassion.

Magnet® Moments at Memorial Hermann-Texas Medical Center

Magnet’s New Knowledge, Innovations andImprovements component encourages professionalnurses not only to engage in research, but also to educatecolleagues on their findings. In early October, staff atChildren’s Memorial Hermann Hospital volunteered theirtime to conduct the first “Sepsis Is Scary” education fair.

The idea originated from Rebecca Hayes, R.N., PICUeducator, who formed a team meeting with pediatric andER educators regarding the new sepsis protocol created bypediatric critical care and emergency medicinephysicians. The team, which included Hayes, MichelleMaixner, R.N., CSC educator, Sylvia Reimer, R.N., EReducator, and Karen Gibbs, R.N., pediatric educator,decided to host a fair to educate staff on how to identifysepsis and advocate for early recognition and treatment ifsymptoms were present.

Gibbs, one of the fair’s organizers, said, “The mainpoint we wanted nurses to take away from our fair is torecognize that sepsis is a national problem and happensmore often than expected. If nurses and physiciansidentify the risk early and advocate for their patients withearly and aggressive intervention, we can really advancethe health of our patients.”

In addition to the educators, fair volunteers includedAmanda Davis, R.N., CCN, Vuong Tran, R.N., CCN,Faleda Cole, R.N., CCN, Jennifer Davis, R.N., CCN,Anjeanette Smith, R.N., PICU, Mashonda Garner, R.N.,RCW, Cynthia Quinoez, R.N., CCN, Tien Pham, R.N.,RCW, Sejal Shah, R.N., CCN, and Jennifer Tesone, R.N.,PICU.

MAGNET MOMENTS:Children’s Memorial Hermann Hospital Hosts “Sepsis is Scary” Education Fair

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“That was probably the hardest part forLarry – waiting and keeping still. Ididn’t know how much longer he wasgoing to be able to mentally handlethat.”

The team continued to monitor himand began to consider inserting a VADshould a heart not become available inthe next few days.

On October 30, Larry celebrated his70th birthday in the hospital with hiswife and the only thing on this year’sbirthday list was a new heart. The verynext morning, he was awakened at 4 a.m. with news that they had found amatch and his birthday wish had cometrue – a heart was being flown in at thatvery moment.

Larry said, “Words truly cannotexpress how I felt. It was the bestbirthday gift I ever got – a life-savingbirthday gift.”

Dr. Gregoric met with Larry themorning of the 31st to discuss thetransplant surgery, which would happenin the next few hours. A routine patientquestion, Larry asked him, “So, howmany heart transplants have you donehere?”

Dr. Gregoric frankly replied,“Zero.” Both Larry’s and his wife’s eyesdarted up in concern. “However, I havedone hundreds as a surgeon at anotherhospital. You will be the first patient toreceive a heart transplant at the newly-formed Center for Advanced HeartFailure.”

After Dr. Gregoric departed, Larry

turned to his wife and said, “I don’tknow what I’m more excited about – thenew heart or that I’m going to be thefirst one at this place to receive a newheart.”

Hours later, physicians at theCenter for Advanced Heart Failureperformed the first heart transplant – amilestone for the Center as well as theCampus. The transplant was a successand Larry continues to feel better eachday.

“Needless to say, I had a wonderfulbirthday and look forward to celebratingmany more, as a result of the great care provided by the talented physiciansand staff at the Center,” said Larry.“This was an experience that has mademe forever grateful and one I will neverforget.”

Volunteers at the“Sepsis is Scary”education fair.

Given our Campus’ success in reducing the incidence ofventilator associated pneumonia (VAP) and central line bloodstream infection (CLABSI) rates, there is a high interest inachieving similar improvement in catheter associated urinarytract infection (CAUTI) rates. This interest has beenexpressed Systemwide, and in January 1, 2013, the accreditingrequirement for the National Patient Safety Goal pertaining toCAUTI will begin.

For the past several months, CAUTI process improvementwork has been underway. Bundles and criteria for indication,insertion and maintenance of indwelling catheters weredeveloped by Drs. Luis Ostrosky, medical director ofEpidemiology and Infection Prevention at MemorialHermann-TMC, Galit Holzmann-Pazgal, medical director ofEpidemiology and Infection Prevention at Children’sMemorial Hermann Hospital, and John Butler, Systemmedical director of Epidemiology and Infection Prevention.The CAUTI workgroup, representing all Memorial Hermannfacilities, has collaborated to establish common operationaldefinitions to standardize the process for the implementationof indwelling catheter bundles.

The improvement process is currently underwaythroughout the System. To ensure patients benefit from thebundles and to have an optimal process in place by January 1,the workgroup has devised an implementation plan to assist in

ensuring staff are trained and appropriate metrics and dataare being collected to evaluate the process pertinent to notonly outcomes, but also work flow.

Juan Inurria, System executive of Quality, Patient Safetyand Infection Control, said, “Your leadership is critical to

(Continued on back page)

To improve quality care Systemwide, a workgroup, representing all Memorial Hermann facilities, established a standardized

process for the implementation of indwelling catheter bundles.

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Recognizing employees for theirachievements in patient care and in ourcommunity is an integral part of theculture of nursing excellence atMemorial Hermann, both at the TexasMedical Center Campus and across theSystem. It is also an importantcomponent of Structural Empowermentto reward and recognize staff, many ofwhom have gone above and beyond theirday-to-day responsibilities to makeachievements in their fields.Congratulations to the followingemployees!

PromotionsPharmacy Promotions for FY13• Trung Nguyen has been promoted

to Pharmacy Tech II• Sharonda Dawson has been

promoted to Pharmacy Tech II• Dora Hernandez has been promoted

to Pharmacy Tech II• Brittany Mendoza has been

promoted to Pharmacy Tech II• Christine Tran has been promoted

to Pharmacy Tech III

• Nayeli Amer has been promoted toPharmacy Tech III

• Jenson Erapuram has beenpromoted to Pharmacy Tech III

• Liny Malath has been promoted toPharmacy Tech III

• Luelreman Obenza has beenpromoted to Pharmacy Tech III

• Itunu Adebola has been promoted toPharmacist II

• Brad Domonoske has beenpromoted to Clinical Pharmacist II

• Christine Domonoske has beenpromoted to Clinical Pharmacist II

• Shannan Eades has been promotedto Clinical Pharmacist II

• Jennifer Gass has been promoted toClinical Pharmacist II

• April Graves has been promoted toClinical Pharmacist II

• David Guervil has been promoted toClinical Pharmacist II

• LaTosha Mitchell has beenpromoted to Clinical Pharmacist II

• Chi Pham has been promoted toClinical Pharmacist II

• Eileen Tharp has been promoted toClinical Pharmacist II

• Phillip Weeks has been promoted toClinical Pharmacist II

• Karen Williams has been promotedto Clinical Pharmacist II

• Christine Whong has beenpromoted to Clinical Pharmacist II

• Teresa Allison has been promoted toClinical Pharmacist III

• Brain Gulbis has been promoted toClinical Pharmacist III

• Christie Hall has been promoted toClinical Pharmacist III

• John Samuel has been promoted toPharmacy Director (Operations)

Achievements• Carla Trevizo, R.N., MICU, received

her bachelor’s of science in nursing.• Sophie Samuel, Pharm.D., B.C.P.S.,

presented a poster titled, “Efficacyof Monitoring Phenytoin LevelsWhen Used for Seizure Prophlaxisin Traumatic Brain Injury” at theNeurocritical Care Society meetingin Denver, on Oct. 6.

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Recognizing Our Employees

Quality Corner: Prevention of CAUTI Implementation Plan

NovemberNov. 19, 8 a.m. – 12:30 p.m. *Class Full

CPR HeartSaver (Non-Licensed Staff Only)Nov. 19, 8 a.m. – Noon *Class Full

Phlebotomy ClassNov. 20, 11:30 a.m. – 12:30 p.m. &

12:30 – 1:30 p.m. CNO Luncheon – Bridging the Nursing Generation Gap

Nov. 20, 8 a.m. – 4:30 p.m. *Class FullCritical Thinking and Decision Making in the Clinical Setting

Nov. 27, 8 a.m. – 5:30 p.m. *Class Full Advanced Cardiac Life Support – Recertification

Nov. 29, 8 a.m. – 4:30 p.m. EKG Interpretation: Beyond the Basics

Nov. 30, 10 a.m. – Noon *Class FullHealthQuest – Nursing ADT

DecemberDec. 3, 8 a.m. – 12:30 p.m.

CPR for Healthcare Providers (Licensed Staff Only)

Dec. 3, 9 a.m. – 5 p.m. *Class FullChemotherapy: Chemotherapy and Biotherapy

Dec. 6, 7:30 a.m. – 4 p.m. *Class FullContinuous Renal Replacement Therapy

Dec. 10 & 11, 8 a.m. – 5 p.m. *Class FullCrucial Conversations

Dec. 10 & 11, 8 a.m. – 4:30 p.m. *Class FullAdvanced Cardiac Life Support

Dec. 10, 9 a.m. – 5 p.m. *Class FullChemotherapy: Chemotherapy and Biotherapy

Dec. 10, 9 a.m. – Noon *Class FullImplanted Vascular Ports

Dec. 11, 8 a.m. – Noon *Class FullPhlebotomy Class

Dec. 13 & 14, 7:15 a.m. – 5:30 p.m. *Class FullTrauma Nursing Core Course

Dec. 13, 8 a.m. – Noon EKG Interpretation: Beyond the Basics (Day 2)

Dec. 14, 9:30 a.m. – 1:30 p.m.Intra-Aortic Balloon Pump

Dec. 17 & 18, 8 a.m. – 4:30 p.m. *Class Full Pediatric Advanced Life Support

Dec. 20, 8 a.m. – 12:30 p.m. CPR HeartSaver (Non-Licensed Staff Only)

Dec. 21, 10 a.m. – Noon *Class FullHealthQuest – Nursing ADT

Continuing Education Opportunities

To register or get more information on any class, visit the Partners in Learning section of InSite.

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(Continued from page 6)

Certifications• Liz Arnold-Jones, R.N., Cath Lab,

received a professional certificationfrom C.V.R.N.

• Kris Colston, R.N., Cath Lab,received a professional certificationfrom C.V.R.N.

• Jeff Dybdahi, R.N., Cath Lab,received a professional certificationfrom C.V.R.N.

• Karen Markley, R.N., Cath Lab,received a professional certificationfrom C.V.R.N.

• Keith Woerner, R.N., Cath Lab,received a professional certificationfrom C.V.R.N.

• Stacey Wallace, R.N., Cath LabHolding, received a professionalcertification from C.V.R.N.

New Leadership• Jane Stirrup, R.N., M.S.N.,

C.P.H.Q., H.A.C.P., has been nameddirector of Clinical QualityIntegration. In her role, Stirrup willbe responsible for ensuring theCampus complies with all applicableregulatory and accrediting agenciesincluding the state of Texas, federal

government, The JointCommission, Medicare, Medicaidand various others. She will alsoapply her extensive expertise to theareas within Quality andPerformance Improvement whichimpact regulatory compliance andthird-party payors. Stirrup will alsobe responsible for understandingthe quality data and expertiserelated to the National Database ofNursing Quality indicators(NDNQI). Her work will connect toall service lines and administrativefunctions.

6411 Fannin | Houston, TX 77030 | 713.704.4000 | www.memorialhermann.org

CLINICAL NOTES EDITORIAL TEAM

Alejandra RodriguezDirector, Communications and Volunteer Services

Lauren AllenMarketing and Communication Rep. II

Victoria King, M.H.A., M.S.N., R.N., C.N.O.R., N.E.A.-B.C.Chief Nursing OfficerMemorial Hermann-TMC

Cheryl Olson, M.S., R.N., N.E.A.-B.C.Chief Nursing OfficerChildren’s Memorial Hermann Hospital

Clinical Notes is a publication of MemorialHermann-TMC internal communications. We welcome your suggestions and comments.

713.704.1222

medicalcentercommunications@memorialhermann.org

Thanksgiving Day – Thursday, Nov. 22Our Campus will be providing a complimentary meal for allemployees who will be working on Thanksgiving Day and third-shiftemployees working on Wednesday, Nov. 21.

Dillard’s Sale – Wednesday, Nov. 28 to Thursday, Nov. 29Dillard’s is bringing their department store to our Campus! Thesale, which benefits Campus improvement projects implementedthrough Volunteer Services, will include a vast selection of

designer handbags, perfume, make-up, designer shoes, brandwatches and much more. The fundraiser will take place onWednesday, Nov. 28 from 7 a.m. to 6 p.m., and Thursday, Nov. 29from 7 a.m. to 4 p.m.

Annual Employee Holiday Party – Thursday, Dec. 20All employees are invited to attend our Campus’ annual employeeholiday party in the Hermann Conference Center from 11 a.m. to2 p.m. and 9 p.m. to midnight.

Upcoming Events

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reaching our evidence-based practice goal before January 1and sustaining success.”

The following agenda includes the time frame wheneducation for the new CAUTI implementation plan will takeplace for your service line.

• Mischer Neuroscience Institute: Nov. 1 to 9• Texas Trauma Institute: Nov. 12 to 16 • Open to any unit and Perioperative Services: Nov. 19 to 20• Medicine Service Line: Nov. 26 to 30 • Heart & Vascular Institute: Dec. 3 to 7• Specialty Surgery/Transplant/Outpatient/ER: Dec. 10

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