SEPTEMBER 2013 | A Magazine for NursesMETHODIST NURSE

Leaders in Nursing

PAgE 8

CASEManagementWeek

Celebrating

THE D E PARTME NT of NURSINg

MAgNET SITE SURvEy at Houston Methodist Willowbrook PAgE 6

IIn October, we will celebrate National Case Management Week as our organization recognizes the work of our dedicated team of case managers and social workers from Oct. 13 – 19. These professionals play a vital role in nursing and have had such a positive impact on the patients and families at Houston Methodist. Inside this issue of The Methodist Nurse, we invite you to get a closer look into our Case Management team and learn more about what they do to expertly provide the key elements of transitions of care.

A few weeks ago, we hosted our 4th Annual Nursing Alumni Luncheon. Once again, so many of our retired nurses returned to our campus for this fabulous event, which continues to grow each year. These individuals are a very important part of the legacy of Houston Methodist Nursing, and they continue to show a strong desire to remain connected to our organization. I enjoyed sharing many of our current nursing programs, our recent accomplishments, and our new name change to Houston Methodist with them. It was also an honor for me to hear their unique stories and see them rekindle relationships with former colleagues. Because of their expansive knowledge base and eagerness to be involved, we are looking forward to creating new volunteer opportunities in which we can involve our retired nurses in a few of our future nursing initiatives.

As we continue to advance nurses along our career ladder, the Clinical Career Path committee is encouraging high performing RNs that have a specialty certification, a BSN, and three years of nursing experience with one year in specialty, to apply for promotion to the RN III level. Our nursing leaders can certainly help in this role by identifying stellar nurses who meet these criteria. Applications can be submitted twice a year (November and April), and we have a team in place that is committed to supporting and mentoring individuals through every step of the application process. Whether it is answering questions, reviewing your clinical narrative, preparing you for the panel interview, or critiquing your application packet, our team is committed to fostering the professional growth and enhancing the clinical practice experiences of our nursing staff. If you or your colleagues would like additional information on the Clinical Career Path, please contact committee co-chair Johnie Leonard.

Continuing with our professional growth opportunities at Houston Methodist, please do not forget about the great access our nursing staff has to CE Direct. I encourage more colleagues to take advantage of this online learning tool, which offers instant access to more than 1,400 award winning courses and a variety of topics nurses see at the bedside—all accredited by ANCC. Beginning in October, users will see two minor changes in the login process. The learner’s login ID will now be their seven digit employee ID number (not their user ID). In addition, our hospital name change will not be reflected in the drop down menu. On the login page, simply look for “Houston Methodist Hospital.” For more information on CE Direct, please contact Bobbi Musgrove in our Center for Professional Excellence.

As always, I thank each of you for the dedication, diligence and enthusiasm you exhibit day in and day out!

National Case Management Week

Ann Scanlon McGinityA Message from

Senior Vice President and Chief Nurse Executive

2013 Editorial Board MembersElizabeth Himes

Beverley Lamoth

Kathy Materre

Denise McNulty

Carlette Patterson

Joy Shiller

Maria Steele

Robyn Washington

Magazine EditorTrevor Mitchell

Graphic DesignerPhyllis Gillentine

PhotographersPhyllis Gillentine

Trevor Mitchell

Do you have a

that you would like

to post in the METHoDIST NURSE MAgAzINE?Please submit your articles or ideas to Trevor Mitchell attmitchell2@houstonmethodist.org

Houston Methodist Hospital presents its...

DAy in the LIFE PRogRAM

THE D E PARTMENT of NURSINg

The Houston Methodist Hospital Department of Nursing’s newly created Day in the Life

Program offers staff members an opportunity to observe, learn, and gain exposure to

other professional hospital careers, roles, departments or specialty areas they may be

interested in. The program creates unique job shadowing and hands-on learning experiences by

matching participants with experienced mentors— who allow interested colleagues to get a glimpse

into their work environment and the day-to-day job responsibilities required in their chosen fields.

If you would like to register to participate in the Day in the Life Program and schedule some time with an individual working in a specific role at Houston Methodist Hospital, or if you would like to serve as a Day in the Life Program mentor and share details about your job, please visit the program’s webpage which can be found under the

Workplace Environment tab on the nursing intranet.

The 2East team with Bruce the Border Collie and handler JoAnn Russell.

The 2West team with Troy the Doberman and handler Debra Dickey.

Jane DeStefanoVice President and Chief Nursing Officer

Houston Methodist San Jacinto News

4 METHODIST NURSE

In fact, there are many research articles that speak to the healing effect of animal-assisted programs on hospitalized patients. A patient’s interaction with an animal can provide positive physical and emotional benefits, such as reducing stress levels and providing a sense of well-being.

Houston Methodist San Jacinto Hospital partners with Paws 4 Love to provide pet therapy to hospitalized patients. Paws 4 Love is a program consisting of volunteers who give their time to hospitals. The handlers and the dogs undergo difficult training and testing to ensure that they are fit to participate in the program.

“Pet therapy is one means to bring joy and comfort to our patients….and all of us. We are hopeful that a little bit of sunshine, in the form of a dog, will help to raise spirits and improve their physical and emotional well-being,” said Donna Gares, president and CEO of Houston Methodist San Jacinto Hospital.

Although the program began with patients in mind, it has become a highly-anticipated weekly occurrence for the nursing staff. The dogs begin each visit by stopping at the nurses station to visit and take photos with the team. Then the dogs are taken to various rooms in the med/surg and OPTU areas of the hospital, spending five to 10 minutes with each patient.

Pet visits are available on Thursdays at the Garth and Alexander campuses of Houston Methodist San Jacinto. We are very excited to offer this unique method of healing and comfort, not only for our patients, but for our staff as well.

Pets bring cheer to patients

As animal lovers are aware, there’s nothing like snuggling up with a four-legged friend to lift your spirits.

at Houston Methodist San Jacinto

LEADERS IN NURSINg 5

CULTUREof

EXCELLENCE

HOUSTON METHODIST SUGAR LAND HOSPITAL (HMSL) once again is considered to be the provider of choice for our primary service area. The September state market data analysis gave this ranking based on a review of 19 key clinical services and specialties. This reflects the excellent, high quality, effective, and efficient care provided by our physicians and staff. As we have always acknowledged, this is only possible through a continual focus on quality care. As a top provider, we have an obligation to serve in a leadership role, exemplified by recent improvements in care coordination and translation of evidence into practice. A culture of excellence invites staff at all

levels of the organization to look for ways to improve. We must think outside the hospital’s walls, considering “How can we continue to lead in our communities?” This was answered Friday, September 20th, when over 20 staff nurses and nurse leaders from HMSL attended Houston Methodist Research Institute’s “2013 Evidence-Based Practice Symposium.” For this symposium, 12 posters from HMSL were submitted. Seven of our nurse leaders presented their posters in this venue, and two were asked to participate in the discussion panels. Listed to the right are the nurse leaders who presented their poster presentations:

All of the examples to the right are evidence that Houston Methodist Sugar Land Hospital contributes to the expansion of knowledge in the community, and to the professional development of nurses. Thank you for providing excellent care —making us the number one hospital of choice in Fort Bend County.

Houston Methodist Sugar Land NewsJanet Leatherwood

RN, MSN, VP / Chief Nursing Officer

Inter-professional Presenters: Poster Presentations & Panel Participant“Massive Transfusion Protocol” Cristina Martin, RN, BSNMona Seele, RN, MSN, CNSBrigitte Tomek, RNC, MSNSeema Mullick, MDDonna Hermis, MHA, FACHE, MT, SCRosalie Thornblom, BS, MTMary Ann Yeung, BS, MT, SBB

“Newborn Screening for Critical Congenital Heart Defects (CCHD)”Sonia Chauhan, MDTracy Bridges, RNC, MSNAmy Cheng, RN, BSNMona Seele, RN, MSN, CNS

“Implementing a Sepsis Tracking Tool” Allison Damron, RN, MSNBetty Gonzales, RN, DNPBonnie Riley, RN, MSNScott Stover, RN, MSN

“Impact of a Rapid Recovery Program on outcomes”Christopher Rappel, RN, MSNTeresa Gonzales, RN, BSNBetty Cheung, RN, BSN

“Early Nutrition in Critically Ill Patients”Patricia S. Lewis, RN, PhD, NEA-BCJenifer Henderson, BS, RD, LDKathleen Murphy, RN, MSN, CPANAileen Velasquez, MS, RD, LD “Hourly Rounds will Decrease Call Lights and Increase Patient Satisfaction and HCAHPS Scores”Ann Maguire, RN, BSNAncy John, RN, BSN, CVRNYves Senat, RN, BSN, CVRNAnju Joseph, RN, BSNRizwana Sunesra, RN, BSNElsie Kurian, RN, BSN, CVRN

“Alarm Reduction with Telemetry Electrode Management”Katherine Vos, RN, BSNTeri Pulanco, RN, BSNMaria Querido, RN, BSNStella Tomy, RN

Panel Participants Participated on a panel discussing the development of the PICoT question, selecting a team and getting started.Katherine Vos, RN, BSN

Participated on a panel discussing analyzing and dissemination of the results.Ambereen Ali, RN, BSN, CCRN

LEADERS IN NURSINg 5

Houston Methodist Willowbrook News

Sheila FataVice President & Chief Nursing Officer

6 METHODIST NURSE

This survey was the culmination of several years of preparation and hard work as we destined ourselves to be leaders in nursing care, discovery, and innovation. Today, I want provide a brief “report” on the survey and recognize the outstanding work of our entire nursing team which led to our success.

As you may know, our Magnet Journey began back in 2010. Since that time we have worked to become an organization where the Magnet principles are central to our daily operation. From shared governance and nurses leading organizational change to producing our first formal nursing research studies, nurses at Houston Methodist Willowbrook Hospital (HMWB) have answered the call to take nursing in our hospital to the next level. Our Journey presented challenges, which were overcome by the dedication of our nursing team to the Magnet vision.

On the first day of our site visit, we greeted the survey team with a cheering army of hospital staff in Methodist blue, kicking off three days of interviews, panel discussions, meal sessions and hospital tours. The survey began with a review of updated documents on patient satisfaction and nursing quality, then moved to interviews with our hospital leadership, directors, managers, and staff nurses. By the end of the week, nearly 150 nurses participated in discussions directly with the survey team. Many of our staff also had the opportunity to join the survey team in one of 13 private meals, giving them the opportunity to talk with the survey team and their colleagues about HMWB, patient care, and the future of nursing at our hospital. The surveyors were also welcomed to 24 patient care units for tours by enthusiastic nurses.

The three days of the survey were certainly a whirlwind! The surveyors posed some challenging questions to our staff during their visit, such as: How would your hospital contribute to the “Community of Magnet” if designated? Can you meet the expectation to publish the great work we’re doing? How would Magnet designation impact your work as nurses?

By the end of their visit, the surveyors had only positive feedback for our team. They praised the nurses for their engagement and ownership of the quality outcomes and patient experiences in their units. One surveyor had the opportunity to speak to a mother whose child was in our NICU. Her story about our staff’s care, attention to her and her baby’s needs, and true personal experience brought the surveyor to tears. They remarked that they loved knowing about our hospital, just in case they were visiting Houston and needed a hospital. As they left, they said it was one of the easiest surveys they had done.

Our entire hospital has every reason to be proud. While we still await a final decision based on the survey team’s recommendations, a final review by the ANCC, and a vote of the Board of Commissioners, we can relish in the excellence in professional nursing that resonates throughout our hospital.

DesTiNaTioN MagNeT!September was a big month for us as we welcomed the Commission on Magnet Designation to our hospital for our official Magnet site survey!

Pictured from l-r: Marcia Malone-Tedder, Dana Scott, Artie Saxena, Barbara Drummond-Huth (Surveyor), Banne Miers (Sur-veyor), Janet Hanley (Surveyor), Sheila Fata, Shari Costigan

Houston Methodist West News

Vicki Brownewell Vice President & Chief Nursing Officer

LEADERS IN NURSINg 7

Pathway to ExcellenceThe journey to Houston Methodist West Hospital’s Pathway to Excellence designation started long before we opened our first door on December 17, 2010. The structures and processes were laid out with collaborative effort from different departments and input from both management and hired

staff nurses, laying the foundation for nursing excellence here at West. Although Pathway to Excellence is a Nursing designation, this award is the culmination of hard work by many people in the organization both nursing and non-nursing.

The American Nurses Credentialing Center’s (ANCC) The Pathway to Excellence® Program recognizes health care and long term care organizations for positive practice environments where nurses excel. To qualify, organizations meet 12 practice standards essential to an ideal nursing practice environment. Nurses trust that Pathway-designated institutions respect their contributions, support professional development and nurture optimal work settings. It is a feat to achieve such a designation after only being opened for two and a half years, with six months dedicated for collection of data and documents to support all the Elements of Performances required for the designation.

The “Pathway Team” was created in October 2012 and is comprised of nurse representatives from the different departments: Eke Onyechefuna, Maureen Teoh, Janice Blackwood and Chyrel Coley from the Med-Surg Units, Mimi Olson from ICU, Cynthia Moratalla from OR, Aisha Olaleye and Denise Austin, both from the Birthing Center, Susan Melton of Infusion Center, Jaime Bethune, Jeanne Frasier and Jan Lim from the Emergency Department, Jane Cherry from

Quality, Kim Holland and Harvinder Kaur from the Education Department and Imelda Oca, PTE Coordinator. Meetings with the team involved brain storming, data collections, project proposals and several collaborations with different departments and management. Each one has given invaluable input and “going above and beyond” efforts. To recognize their contributions, CNO Vicki Brownewell held a Pathway

to Excellence celebration on August 22, 2013. At the same event, “The DAISY award”, a project by the Professional Development Council, was

introduced, the event was attended by our CEO, fellow nurses, and other departments in support of nursing.

Although Pathway to Excellence is about practice environments, its quality is measurable by the superior patient outcomes and other nurse sensitive indicators we are most proud of here at West we remain true to our Nursing department’s mission: to serve, educate and excel by providing leadership and excellence in practice, education and service to the patient, family and community.

HMW’s journey to Pathway to Excellence continues even after receiving the designation on August 14, 2013. Excellence does not have an end...the ride has just begun. And, what a journey it has been.

BY: IMELDA OCA, RN BSN CCRN

“We are what we repeatedly do. Excellence, therefore, is not an act, but a habit.”

- Aristotle

Case MANAGEMENT:

Many health care organizations throughout the nation rely heavily on their team of case managers and social workers to provide support and assistance during the care delivery process. Effective case management requires plenty of collaboration among interdisciplinary staff members and centers on assessing, planning and coordinating available service options to meet a patient’s medical needs. Achieving quality and cost-effective outcomes are also key priorities for all case management staff.

Hospital case managers are registered nurses with clinical experience, and usually possess a nursing degree and certification. The social work staff members hold a master’s degree in social work, including a hospital clinical internship. Together, these two professional groups are deeply valued for their understanding of health care delivery and their knack for combining quality, efficiency and resource utilization into effective discharge plans for patients. Our case manager and social work teams play an integral role when it is time for a patient to be discharged—oftentimes connecting patients with community services and post-acute care facilities.

“The job of a case manager is twofold because we serve as advocates for both the patient and for the hospital,” says HMH case manager Audrey Thomas, RN, CM, ACM. “Verifying insurance and making sure all criteria is being met is a huge part of the job as well as discharge planning. Our team likes to stay aware of new health care trends and policies so that we are always well-prepared to make the best recommendations and handle each and every scenario.”

At Houston Methodist Hospital, our case management team is comprised of over 50 case managers and 40 social workers. These professionals are assigned to various hospital units, including the Emergency Department and the Transplant Center. They are involved, and must be knowledgeable of various areas since they interact with every patient that comes through our doors. The case managers and social workers form strong teams communicating openly with bedside nurses to learn each patient’s personal story and

8 METHODIST NURSE

By: Trevor Mitchell, Nurse Marketing Analyst Expert Advocates Impacting Clinical Care

LEADERS IN NURSINg 9

CASE MANAgEMENT ROLE• Advocacy & Education – ensuring the patient

has an advocate for needed services and any needed education.

• Clinical Care Coordination/Facilitation – coordinating multiple aspects of care to ensure the patient progresses.

• Continuity/Transition Management – transitioning of the patient to the appropriate level of care needed.

• Utilization/Financial Management – managing resource utilization and reimbursement for services.

• Performance & outcomes Management – monitoring, and if needed, intervening to achieve desired goals and outcomes for both the patient and the hospital.

• Psychosocial Management – assessing and addressing psychosocial needs including individual, familial, environmental, etc.

• Research & Practice Development – Identifying practice improvements and using evidence based data to influence needed practice changes

*courtesy of the American Case Management Association (ACMA)

background in order to ensure the appropriate care is provided.

“As social workers we have many opportunities to work with patients, family members and the treatment team regarding psychosocial issues, transitions of care, patient rights, advocacy and palliative care,” added John Ontiveros, LCSW,

HMH Transplant social worker. “One of the most rewarding aspects of my position is the opportunity to work with the multi-disciplinary team to enhance the patient experience at Houston Methodist.

Contrary to what many may think, case management responsibilities do not always end at discharge. Many times, our team follows-up with patients by collaborating with care navigators, who are responsible for post discharge phone calls to help prevent readmission. This is a very important step in easing the transition from hospital to home.

“Case Management is definitely a different side of nursing, but there still are plenty of opportunities for patient contact,” said HMH case manager Shelby Wiley, BSN, MS, RN. “My role has been very fulfilling and gratifying to me. Like most of us, what I enjoy is having the opportunity to see the end result—ultimately seeing the patient return home with the support that they need.”

In today’s ever-changing health care landscape, there has never been a better time to work in case management. And, the high level of patient acuity being found in hospitals nationwide only adds to the importance of having an experienced and dedicated team of case management professionals. During National Case Management Week, which runs from October 13-19, our organization would like to recognize our high performing case management team for their tremendous efforts and contributions.

“It‘s obvious the Houston Methodist organization truly values what we do and what we bring to the health care team,” said Thomas. “Collectively, I think our team has over 300 years of case management experience, so we use all of that knowledge to help our patients reach the best outcome possible.”

Audrey Thomas, RN, CM, ACM, and Shelby Wiley, BSN, MS, RN

10 METHODIST NURSE

As part of the Clinical Scholars Program, scholars at Houston Methodist Willowbrook (HMWB) are utilizing project plans to

communicate financial and human resource impacts for their proposed projects with the EBP team and management. The Project Plan format was the brain-child of Wendi Froedge, MSN, RN, CCRN, Critical Care Services –RN IV. Taken from one of the template formats in Gary Heerkins’ book, The Manager’s Guide to Project Management (2002), Wendi revised the project plan to meet the needs of a critical care service project initiative. At the outset, it was clear that the clinical scholars needed help in development of a Project Plan. Mona Cockerham, MSN, RN, Nursing Quality Specialist, and Robin Howe, MSN, RN, RNC-OB, Family Centered Care RN-IV and Leader of the HMWB Clinical Scholar Program, developed step-by-step instructions for Project Plan preparation. This format can be used for nursing projects as well as for all interprofessional EBP projects.

DescriptionThe project’s description includes the title of your project and the goal you are trying to accomplish. The project should not last more than 12 months and the title should include enough information to differentiate it from any prior projects.

StakeholdersIt is important to identify and include the stakeholders in the development of a project plan. Stakeholders are the participants and/or beneficiaries of the proposed changes. For example, if the clinical scholar is proposing a change in a process involving physician orders, nursing tasks, or procedures, the stakeholders might include physicians, CPOE committees, Policy committees, Education, and the nursing

organization. Be sure to include ancillary departments such as Supply, Laboratory, Imaging, Pharmacy and IT.

Resource RequirementsOne of the most important parts of the Project Plan is to identify the resources that will be required to support the proposed change. The Project Plan is a dynamic document that encourages frequent updates as more information is identified, but it begins with projected financial and human resource investments.

ApprovalsIt is important to obtain leadership approval for the project to ensure leadership support for financial or personnel expenditures. This approval ensures that the project has organizational support for the proposed change and that the project is included in the unit, department or organizational strategic plan and quality project reviews.

TimelineIdentify primary activity such as the acquisition of equipment or rolling out staff training modules by activity and anticipated start date. It is important to identify the item that will be provided as a result of the activity.

other ActivitiesOther Activities timeline describes interprofessional activities which impact support throughout the ancillary departments or hospital-wide.

By: Robin Howe, MSN, RN, RNC-OB

DEVELOPING A PROJECT PLAN for EBP Projects

Key Activities (Interprofessional/Hospital wide)

Develop Education Plan and Mock Code Time Table

Major DeliverablesOwner 3/15 4/15 Description

Education Plan Mock Code Educator x Implementation FCC team x Schedule

oTHER ACTIvITIES

LEADERS IN NURSINg 11

RisksKey to the success of the project is the ability to forecast the constraints, barriers and risks that prevent implementation and proposed strategies to overcome or ameliorate the risks.

MetricsEvery project is evaluated by its priority to the organization in terms of providing a change related to either problem-based or knowledge-based triggers. In order to determine the need for change, and the impact of implementing the change, the project leader must identify the metrics that will be used to determine the priority and successful completion of the project. “Measures” refers to what is being measured; while “Measurer” refers to the benchmarking organization, such as HCAHPS or NDNQI benchmarked databases. It is important to identify the benchmark criteria within the Measures block, for example 60%.

Measures Measurer Baseline

Length of time; outcomes; degrees of change; percentage of compli-ance reported by HCAHPS, UHC, NDNQI, professional organization (AAORN) or internal benchmarks

Who will collect and produce the data

Prior Quarter

METRICSCycle 1 (Weekly, Monthly or Quarterly)

Cycle 2 (Weekly, Monthly or Quarterly)

Cycle 3 (Weekly, Monthly or Quarterly)

Key Successes

Resource

Lessons Learned

Costs

Utilization of labels, clipboards provided seamless response

Example: staff attending training outside of normal working hours

Provide more hands on training prior to Mock Codes

None. All training performed during normal working hours.

SUCCESSES AND LESSoNS LEARNEDDuring the course of the Initiative, enter the successes and lessons learned.

RESoURCE REqUIREMENTS (ACTUAL)During the course of the Initiative, enter actual costs associated with the Initiative

Communication The Communication Plan describes what needs to be communicated, who needs to know, when they need to know, how the information will be disseminated and who needs to communicate the message.

Successes, Challenges & Actual Resource RequirementsThe final two segments are also updated throughout the course of the project. Identification of successes and challenges provide an opportunity of learning related to future EBP projects, while actual resource requirements identify positive or negative changes to the budgeted resources associated with the project.

Utilization of this Project Planner also provides the project leader a “to-do” list that aids in communication of plans, processes, and interface needs with interprofessional staff. Although the Project Planner is not meant to be a report card, the EBP project leader can participate in the ongoing self-evaluation of a successful EBP project implementation and management, and provide documentation of the project evolution and completion process.

THE oPERATINg RooM (oR) is a unique environment for all skill levels. Introduction to the OR is provided for the surgeons, physician assistants, first assistants, nurses, perfusionists, and surgery technicians. The nursing assistant programs currently offered do not have an operating room component to their programs, which often leaves applicants for the position of OR nursing assistant without any background in the operating room. When hired into the OR, these new employees must be trained for work in this specialized area. That means on the job training through the Perioperative Nursing Assistant Program.

With OR managers and nurses recognizing the unique role of the nursing assistant, Hong Tran, OR Director, was instrumental in piloting this program in Scurlock Operating Room. The course was developed with the assistance of seasoned nursing assistants, who contributed content suggestions and feedback for the educators.

The classes are currently presented quarterly to both novice and experienced perioperative nursing assistants at Houston Methodist Hospital. Their feedback continues to be positive regarding the education they are receiving.

Class topics include: role of the PNA, aseptic technique, and safe movement in and around the OR.

The Workforce Grant awarded to our organization provided a pilot geared at taking an individual from an ancillary role such as housekeeping and dietary services to a new role in the OR. Employees began signing up for the classes being offered, which demonstrated their willingness to expand their horizons through education and self motivation. The program’s goal is to offer a platform for the worker to move into an OR role. By providing this PNA program, we hope that participants will progress into programs for other health care specialty programs such as sterile processing and surgical technology.

Our first class held in January, 2013, at HCCS Coleman College, had a full roster. Beverley Anderson, RN, CNOR, and Debra Belgard, RN, CNOR, taught 10 students from Houston Methodist entities. The students were educated through lectures, skills labs and shadowing opportunities with a PNA. Our experienced PNAs from FBOR, Dunn 3 OR, Dunn 6 OR, OPC, Neurosensory OR and MOR spent a day sharing real world OR experiences with the participants. Each student provided positive comments about their experience and expressed their desire to work in the Operating room setting.

PerioPerative NursiNg assistaNt Program

12 METHODIST NURSE

By: Beverley Anderson, RN, CNOR; Debra Belgard, RN, CNOR; and Christine Castillo, RN

By: Beverly Hughes, MS, RN, AOCNS

The first encounter involved a patient needing to receive an oral chemotherapy drug. However, the drug was in capsule form and the patient was unable to swallow the pill. Our unit-based clinical specialist, Hanna Zaghoul, Pharm.D, requested the support of Chas Gray, R.Ph., to assist with the compounding of the capsule into a liquid so that chemotherapy could be given through the patient’s feeding tube. Gray and Zaghoul reviewed the literature and also spoke with the manufacturer to devise a plan for the compounding process. This process was intense and involved the emptying of the contents of the capsule, adding and mixing in two additional medications, and placing it all into a large syringe.

Ironically, on that same day, the M8NW nursing staff and the OPC 22 Pharmacy worked exhaustively to develop a plan to instill a biotherapy drug into a peritoneal catheter. In this instance, the M8NW nursing staff relied on the support of the Peritoneal Dialysis (PD) staff to help with obtaining the equipment needed to drain the catheter. The PD staff’s commitment and willingness to teach several of the M8NW staff members and answer many questions proved to be a wonderful experience for our team. After draining the peritoneal catheter, the nurse was able to administer the biotherapy drug.

Several interdisciplinary team members on Main 8 Northwest recently exhibited great leadership and clinical expertise coordinating two rather complex chemotherapy administrations.

SPECIAL THANKS goes out to the OPC 22 Pharmacy staff, Chas Gray, Hanna Zaghoul, Sana Haj-Khalil, Gail Messner, Maria Mwamuka and the staff on M8NW under the leadership of Jason Wall and Melva Perdido.

INTERDISCIPLINARy TEAMWORKin Action

14 METHODIST NURSE

BABySafety Month

While infants are particularly more vulnerable to accidents than adults, oftentimes they can be avoided. On September 26, 2013, staff members from our Women’s Health unit celebrated National Baby Safety Month with an informational booth in Crain Garden. The group engaged many visitors and Houston Methodist employees by presenting important facts and safety tips. Topics discussed included: general safety, childproofing, child safety seats, fire and water safety, Sudden Infant Death Syndrome, age appropriate toys and more.

Over 60 retired nurses from Houston Methodist Hospital returned to our campus for our 4th Annual Nursing Alumni Luncheon. Ann Scanlon McGinity, PhD, RN, FAAN, senior vice president and chief nurse executive, provided an update on current Methodist nursing programs and also thanked the attendees for their dedication and individual contributions that have paved the way for today’s nurses. Many members of the group enjoyed visiting with former colleagues and participating in guided tours of the hospital. We are looking forward to hosting our Nursing Alumni event again in 2014!

4th4th annual Nursing alumni Luncheon

PREVENTING, DETECTING & TREATING DELIRIUM

In July 2012, Houston Methodist was awarded a CMS (Centers for Medicare and Medicaid Services) Grant to implement a program for detection and prevention of delirium for inpatients on acute units. By October, all acute inpatient units at Houston Methodist –TMC and all units at Houston Methodist San Jacinto will be screening for delirium. The nurses use the modified CAM tool in MethOD to assess patients age 70 or greater for signs of delirium or new confusion. Once a positive delirium screen is identified, the physician or nurse practitioner should be called to assess the patient and provide appropriate management.

CAM Compliance percentage is monitored daily on each unit. When an outstanding unit is identified by the delirium team, they are recognized with special treats and signage for their unit. Dunn 4 West is the Unit of the Month since they reached the highest possible percentage – 100% for the entire month of August 2013. Two other units achieved great scores as well- Jones 9-IUM -96% and Dunn 7 East – 91%.

Research reveals that many nurses and other health care providers do not readily recognize the symptoms of

delirium. Those patients with hypoactive delirium may be harder to identify and the modified CAM will help detect a recent onset of confusion. Even though patients who have an episode of delirium may quickly recover, they are still a higher risk for falls and complications in the hospital, then greater risk for future issues such as nursing home placement, and dementia. After discharge, Care Navigator nurses follow up with patients at risk for delirium to verify a safe transition to home and appropriate follow up with their primary care physician.

A group of specially trained volunteers called Team CLARITY are a very important part of the grant. These volunteers visit patients ages 70 or greater that are at risk for delirium to teach families about prevention techniques and how to improve the outcomes of their stay. When a patient is identified with a hearing deficit, they will deliver a hearing amplifier to use while they are in the hospital. Magnifier glasses can be given to patients as well.

If you have any questions about Delirium, please email our team at: facedelirium@houstonmethodist.org.

LEADERS IN NURSINg 15

By: Betty Clark, BSN M.Ed. RN CRRNRN IV – CMS Delirium Grant

Congratulations to Rachel Murphy, R.N. from NICU, who

obtained her certification in critical care nursing.

Congratulations to Simone Dobbs-Wilson, R.N. from NICU, who graduated from Western Governor’s University with her MBA/Healthcare Management degree.

Congratulations to Elizabeth Kinder, R.N., from MICU, who recently passed the CCRN exam. Way to go!

Congratulations to surgical tech Ana Espejo, from Dunn 3 OR, who was recently honored by HCC’s Coleman College for Health Sciences Surgical Technology Program as Preceptor of the Year for Houston Methodist Hospital.

Kudos to Kermell Akut for passing his CCRN certification exam.

Congratulations to Tisha Meca for passing her cardiovascular certification exam.

Karen Cole, R.N., C.N.o.R., C.R.N.F.A. and Michelle Ebrahimi, R.N., from Dunn 3 OR, recently co-authored an article entitled “Finding a Needle in the Dark,” which will be published in the November issue of AORN Journal. Way to go!

Kudos to Fran Feltovich, M.B.A., R.N., C.I.C., C.P.H.q., who has been asked to serve as a grant reviewer for the Health Care Innovation Awards given by the Centers for Medicare and Medicaid Innovation Center, Federal Grants Center of Excellence. Way to go!

Congratulations to Jennifer Hnatov, R.N., from CVICU, who recently passed her CCRN certification exam. Great job!

AccoladesNursing

NewsThe Methodist Hospital is proud to have nurses who are dedicated to the nursing profession, driven to achieve growth in their professional development, and creative and always compassionate in their care for patients.

The accolades page is an opportunity for the nursing staff to showcase a few of the many exciting tributes our nurses receive. Please submit kudos to: tmitchell2@houstonmethodist.org.

Congratulations to Mary Katrina Hampton, R.N. from Rehab, who was selected by the Professional Nurse Advisory Council our latest Daisy Award winner. Mary Kristina was nominated for being an exceptional nurse who went above and beyond for a recent patient visiting Houston Methodist. Way to go!

Jared Pittsenbargar, from Radiology, was recently selected as this month’s Nursing Support Team Appreciation and Recognition (STAR) Award winner. The STAR Award recognizes team members who offer support to our nursing staff and help to enhance the Methodist Experience for our patients and families. Eligible persons all nursing support staff and any Houston Methodist employee that does not work as a direct care nurse. Team members may be nominated by patients, families, colleagues, physicians and staff.

Congratulations to Lorie Lazaro, M.S.N., R.N., C.M.S.R.N., - for earning her Master’s degree in Nursing Informatics.Congratulations to Libby John, R.N.-B.C., - for passing Med Surg Certification Exam.

Anne Stiles, Ph.D., R.N., Julia McElwee, R.N., and Shannan Hamlin Ph.D., R.N. recently had an abstract accepted for presentation at the 2014 Southern Nursing Research Society’s 28th Annual Conference. The title of the presentation is “Content Validity of the McElwee Acute Care Patient Acuity Tool (MACPAT).” Great job!

Congratulations to Xavia Holmes, R.N., from NICU, who obtained her CCRN certification.