Magnet Readiness Update Evidence-Based Practice (EBP)

Shared Governance Updates

Focus on BRMC Pulmonology Clinic

SG MEETINGS CANCELLED THIS

MONTH

OCTOBER 2020

Shannon Nachtigal, MSN, RN, NEA–BC–Chief Nursing Officer (CNO), VP Patient Care Services, Administration

COVID-19 and the talk of COVID-19 is all around us. It seems to be an unending source of stress; mask mandates, our kids in school, COVID patient care, what if I get it? What if my family or co-workers get it? Can I get tested? All things COVID have consumed our minds to the point we are ready to get back to life as we knew it. We are ready to go on trips, go to concerts, stop screening, stop wearing masks, have weddings and other social events without limitations. I understand and could not agree more; however, it is not over yet. As people who work in a healthcare environment, we are role models to our community. We need to prevent the spread so we can move on from this pandemic. Please be mindful, as we see an increase in positive cases daily at BRMC, that when you are at the grocery store or other business places in town, you ARE BRMC, and you model the practices that we have embraced. This is not a directive but simply a request that we lead by example for our community.

Magnet Readiness Update Barb Dyson, MSN, RN–Magnet Program Director, Director of Clinical

Excellence, Nursing Administration By now, many of you are aware that the Magnet Appraisers are coming to BRMC soon. There is much activity as we are getting prepared for our virtual site visit. Our Magnet Champions for the inpatient units are in place and working hard to bring you all the information you will need to answer any question they may ask successfully. Have you heard? Magnet Mondays have started, and if you have not yet been part of them ….. you soon could be. The Magnet Readiness team is touring

each unit on Monday to test the technology and prepare the staff to “talk” virtually with the appraisers. The Clinical Nurses and the interprofessional team members who have participated so far have done a fabulous job. It is an exciting time to be working at Baxter Regional. We have so much of which we can be proud. Thank you for all your hard work in getting us prepared for the Magnet site visit.

Evidence-Based Practice (EBP) Dr. Linda Latting, DNP, RN–Director Ambulatory Clinical Nursing, Chair EBP

Team Hello everyone! I hope you are enjoying this beautiful fall weather! The Evidence-Based Practice (EBP) Mentor Team was privileged to present EBP to the RN Residents last week. We enjoyed the interactions with the new nursing minds and hope we were able to entice them to join our team in the future. We explained the importance of EBP and how it impacts their lives as nurses. Not only does it affect their patients’ outcomes, but it also makes a difference in their practice setting. The EBP Team shared the following picture with the RN Residents as a perfect example of why we must speak up to affect change! Please join your Unit Based Council and attend Shared

Governance to ensure your voice is heard! We are listening!

FROM OUR CNO

Journey to Excellence October 2020 Page | 2

SHARED GOVERNANCE UPDATES Start Times Shared Governance NDCs Location: Patterson Room, First Floor

PLEASE NOTE TIMES BELOW

Practice Council 0730 – 0830

Development Council 0900 – 1000

Safety/Quality Council 1030 – 1130

New Knowledge and Innovation Council (EBP/Research/PI) 1200 – 1300

Coordinating Council 1300 – 1400

Leadership Council 1400 – 1500 (CNO, MPD, SG Chairs/Co-Chairs, Nurse Leaders)

SG Nursing Divisional Councils (NDCs) OUR 2020 OFFICERS ARE:

Chair Practice NDC: Kamie Swanson, BSN, RN, CRRN–Clinical Nurse, Acute Rehab (3E)

Co-Chair Practice NDC: Hannah Blasdel, BSN, RN–Clinical Nurse, ICU

Chair Development NDC: Megan Wunderlin, RN, RNC-OB, IBCLC–Educator, WNCC

Co-Chair Development NDC: Jennifer Bohrtz, BSN, RN, WCC–Wound Nurse, Nursing Administration

Chair Safety/Quality NDC: Allison Carter, ADN, RN–Pre-Surgical Testing, Pre-Op

Co-Chair Safety/Quality NDC: Angie Knight, BSN, RN–Clinical Nurse, Family Clinic on Market

Chair New Knowledge and Innovation NDC: Leigh Ann Dowling, MSN, RN–Clinical Informatics Analyst II, Clinical Informatics

Open: Co-Chair New Knowledge and Innovation

For more information, please contact any Chair or Co-Chair above. We use the September SG Day for our annual Summit. The NDC meetings are not held in December as we dream and plan for the next year. The Nursing Divisional Goals must support and align with the UBC’s goals that drive the focus and

intent of Shared Governance as a whole.

Magnet Readiness Team Megan Wunderlin, RN, RNC-OB, IBCLC–Educator, WNCC Magnet Mondays are here! The Magnet Readiness Team is thrilled to bring you Magnet

Mondays. That means we are taking a virtual Barb Dyson, MSN, RN to the inpatient units to practice for a virtual site visit. Thank you 3 East, 3 West, 4 South, 5 South, and 3 South for being the first units to be virtually visited. Everyone who participated did an excellent job of highlighting the outstanding care provided at BRMC. Your unit could be next. Here are some things to think about…..how does your nursing practice line up with BRMC’s Professional Practice Model? Can you explain the types of patients you take care of on your unit and your primary role? What makes you proud to work at BRMC? Do you know where to find your unit’s quality data and the Nursing Core Professional Documents? These are all things that will prepare you for chatting with Barb now and real Magnet Appraisers on our virtual visit. Another fun opportunity on the horizon is the Magnet Welcome Video that will be filmed the week of November 2nd. Each unit has been asked to choose an area they want to showcase. You can decorate with signs or banners, and feel free to wear matching shirts. We want to see what makes your unit unique. Every area is invited to participate. Ask your unit’s Magnet Champion for more information.

Practice Council Co-Chair Hannah Blasdel, BSN RN–Clinical Nurse, ICU

Happy fall, everyone! Can you believe we have made it to October? 2020 has undoubtedly been a long, tough year, but we are getting through it. Keep up the great work! At our September Practice Council meeting, we discussed our most recent EMR optimizations. Some significant changes have been made, specifically to our admission process, to make charting a quicker, easier process. One item to note, however, is charting a height/weight upon admission. It was brought to the Practice Council's attention that, since the height and weight fields have been removed from the intake form, a BMI is no longer calculated. It will be necessary to chart the patient’s height and weight via the PRN task on the tasklist to correct this. Taking this step will ensure a BMI is calculated appropriately. Other topics discussed were the hazardous drug protocol, which will be included at our Skills Fair later this month, and updates on the Sim Lab. As a reminder, Practice Council meets the third Thursday of every month at 0730. We welcome you to join us and let your voice be heard!


Development Council Co-Chair Jennifer Bohrtz, BSN, RN, WCC–Wound Nurse, Nursing Administration

Fall is finally here. I hope everyone is enjoying the cooler weather. I know I am! October offers many development opportunities; the biggest event coming up is the annual RN Skills Fair on Oct. 26-28 in the LDR. Other highlights from Development Council include:

Student Loan Reimbursement applications are available; please talk to your leader if you are interested in this program.

Sapphire PCA pump education was completed at the end of September, and the pumps will be arriving on the units soon.

Peer-to-Peer feedback is now available in TLC. Take a few minutes to review your feedback and set some goals for the next year!

Magnet Mondays have resumed. A great way to prepare for our Magnet visit is to start asking yourself, “What makes you proud to work at BRMC?”

Shared Governance was delighted to hear an update on the progress of our SIM lab from the new coordinator CJ Newton. Welcome to BRMC CJ. We are excited to add the SIM lab to our professional development toolbox!

The PES survey is currently available; leaders are looking forward to reading feedback about your unit!

The BRMC Food Pantry has bags of groceries available for those in need. Please contact COC if you have a patient you think may qualify.

Safety/Quality Council Allison Carter, ADN, RN–Clinical Nurse, Pre-Surgical Testing, Pre-Op

Happy early Halloween! This is my favorite time of the year. I have already been to the local haunted house Fields of Terror in hopes of getting a fright or two. Another thing that might be frightening to people is Covid. As we get new cases in our community, please be mindful of wearing your masks appropriately and continuing with good hand washing practices. In September, the falls task force discussed we currently have three fall contracts in place. The team is working on reducing to one standard fall contract for the facility. Our pressure injury task force reported we have reduced pressure injuries by 50%. Way to go, BRMC! Our CAUTI task force is reviewing all cases at BRMC. They are looking at data, especially on patients arriving at the facility with a catheter in place. We are getting prepared for our Magnet site visit! Our current Fall/CAUTI/CLABSI data is all in the green. This data is displayed as a period encompassing eight quarters. Each department has a quality board with this data placed near their unit. Surveyors will want to view the quality boards in each department. The Magnet Readiness Team will ensure the data on the quality boards are updated.

Simulation Center C.J. Newton, MSN, RN, NE-BC Simulation Center Coordinator

What patient care situation scares you the most? Code Blue? OB emergencies? Trauma codes? Malignant hyperthermia? I started my nursing career on a cardiac telemetry unit. The first time one of my assigned patients arrested on my shift, I went to the nurses’ lounge and cried while the Code Blue team and my peers ran the resuscitation. Obviously, that is not how it should be! What led to that response? Didn’t I know better? Well...not really. I had only been a nurse for five months, and nurse residency programs had not been invented yet. Preceptors made many assumptions at that time that newly graduated nurses knew more and were far more confident than was actually true of myself and most of my peers. To make matters worse, the unit and organization's culture at that time was more about shame and blame when things went wrong than it was about transparency and learning. In short, I did not feel safe being speaking up about what I did not know or was not comfortable doing. Let’s imagine a different scenario. What if, on the day that my patient arrested, I had already practiced resuscitation at least a couple of times in a simulated setting? What if someone had helped me understand the importance of being physically in the room for the resuscitation, even if I could not do much more than give a report? What if the organization's culture encouraged speaking up when I wasn’t sure exactly how to do something and then provided education and practice for me as needed? The BRMC Simulation Center gives us the opportunity to learn and practice in a safe, realistic situation when we are transparent about our learning needs. The space is coming to life this month with the installation of the manikins and related technology. Training for instructors will be held in November, and simulation-based educational activities begin in December!


The DAISY Team Susan Musgrove, MSN, RN–Director ICU

The DAISY Team has been quite busy as of late. Our quarter 1 DAISY Award winner was Linda Walley from 3 South, and quarter 2 was Sherry Prichard from 3 West. Their stories were absolutely fabulous and very heartfelt. Fantastic job, ladies! We celebrate your compassionate care and efforts aimed at nursing excellence. Our second annual Team Award went to 4 South! Again, it was a very touching story,

and we had approximately 18 team members who were recognized for their outstanding care delivery. Great job, 4 South! You make us so proud. We live in a very different and fluid time in healthcare, and the touching stories describe how these people impact others in such a positive way. That is what it is all about, isn’t it? Caring and compassion extended to those in need on a level that leaves an imprint on the lives of those who entrust us with their care. It just does not get any better than that!

New Knowledge and Innovation Chair Leigh Ann Dowling, MSN, RN–Clinical Informatics Analyst II, Clinical

Informatics and Robert E. Lee III ADN, RN Endoscopy

Please join us by participating in the 2020 RN PES survey open now and continuing through October 25th. Eligible RNs watch for emails containing the link and code for the survey.

Here are some key points to remember about the survey:

Use any internet-capable device (only link and code needed)

Make your voice heard

Anonymous & confidential

Good Catches Allison Carter, ADN, RN–Clinical Nurse, Pre-Surgical Testing, Pre-Op

We received a total of 35 good catches for September! Way to go, guys! After meeting and discussing the good catches, this one stood out, and Brooke Barger, BSN, RN, CLC from Women and Newborn Center is the winner for September: A nurse received a verbal order for 1000mcg oral Cytotec every 6 hours from the physician for cervical ripening. The order was placed and approved by the pharmacy. During shift change, the dosage was questioned (the patient had not been given a dose). The nurse, Brooke, felt this dose was incorrect. The director of the unit was contacted and recommended to call and speak with a pharmacist. The pharmacy determined that 1000mcg was an inappropriate dose. The order was then clarified with the physician, and the order was changed to the correct dose of 100 mcg. Thank you, Brooke, for recognizing this incorrect dose and keeping your patient safe! Another honorable mention goes to 5 South’s Hannah Strain, ADN, RN. Her patient was prescribed tramadol for pain. She noticed the patient had a history of seizures, and tramadol can increase the chance of seizure. The APRN was notified, and tramadol was discontinued before being given to the patient. Alternate pain medication was ordered. Way to go, Hannah! This is an excellent example of how to keep your patient safe while at BRMC.

RN participation in the PES shares the Voice of Nursing here

at BRMC. The following are a few of the changes brought

about because of your participation in past surveys:

Improved staffing ratios

Pay increase for BSN

PERLS and Certification reimbursement

Recognition of staff achievement through ICAREs,

gift cards and acknowledgement in staff meetings

Nurse/physician relationships. Shannon meets with

physicians regularly to deal with poor behavior

Meal breaks: Buddy system, relief staff in OR for

lunches


SG Ethics Team Kim Foxworthy, MSN, RN–Manager STEMI/Standards/Education Advisor; Chair Nursing Division

Standards; Ethics Team Advisor; Transition to Practice, Nursing Administration Join us for our October ethical discussion: Ethical implications of the COVID-19 vaccination: to receive or not to receive (that is the question at hand)! Doors open on SG Day Thursday at 1:20 PM sharp; all are welcome to attend!

October 15, 2020 from 1:20-2:00 PM HIM Training Room (1st-floor hallway to cafeteria)

Nursing Division Standards Team Kim Foxworthy, MSN, RN–Manager STEMI/Standards/Education Advisor; Chair

Nursing Division Standards; Ethics Team Advisor; Transition to Practice, Nursing Administration Flu season is upon us; do not forget to review our Lippincott influenza standards!

Immunization Protocol for Patients: Influenza

https://procedures.lww.com/lnp/view.do?pId=5051740&hits=influenza,flu&a=true&ad=false Mini Flu Plan https://procedures.lww.com/lnp/view.do?pId=2051386&hits=flu&a=true&ad=false Bed Management During Flu Season https://procedures.lww.com/lnp/view.do?pId=2103593&hits=flu&a=true&ad=false

Transitions to Practice (T2P) Kim Foxworthy, MSN, RN–Manager STEMI/Standards/Education Advisor; Chair

Nursing Division Standards; Ethics Team Advisor; Transition to Practice, Nursing Administration

Participating units: ED - ICU - 3 West - 4 South - 5 South - WNCC - Acute Rehab

36 RNs have gone through the program to date

100% of preceptee participants agree or strongly agree that the T2P program is effective

New process: UBCs hand-deliver a welcome card with an invite to UBC meetings AND an SG divisional brochure to each new hire

Learning Plan will move to TLC in 2021!

Core skill competencies will become part of T2P in 2021!

Nursing Education James Dabney, BSN, RN–Educator, Education

It is a busy time in Nursing. We have switched our PCA/Epidural pumps, we are getting ready for our Baxter IV Pump upgrade on October 20th, and we are planning for our annual Skills Fair. This year we are including CNAs/Nurse Techs in the Skills Fair.

https://procedures.lww.com/lnp/view.do?pId=5051740&hits=influenza,flu&a=true&ad=false

https://procedures.lww.com/lnp/view.do?pId=2051386&hits=flu&a=true&ad=false

https://procedures.lww.com/lnp/view.do?pId=2103593&hits=flu&a=true&ad=false


Wound Care Jennifer Bohrtz, BSN, RN, WCC–Inpatient Wound Nurse, Nursing Administration

Have you ever asked yourself: “What is alginate, and what wounds is it appropriate for?” “What does epithelialization mean?” “How do I stage this pressure injury?” “What is required regarding a skin assessment on admission?” “How do I tell the difference between a diabetic and venous ulcer?” If you have asked yourself these or similar questions, there is a resource available to you on the inpatient nursing units 24/7!

It is called the Wound Resource Manual, and you will find the answers to all these questions and so many more! Please take the time to review the information regularly. The monthly wound words are also in the back of the binder for reference, including topics such as skin tears, compression wraps, and product spotlights. If you have any ideas on making this resource more user friendly, please let me know!

RN Residency Amy Myers, MSN, RN, NPD-BC—RN Residency Coordinator

RN Residency Professional Development sessions are facilitated by a variety of Subject Matter Experts (SME). Physicians, APRNs, Senior Leadership, Nurse Leaders, Clinical Nurses, and ancillary staff participate in the SME role for the BRMC RN Residency. The SME discusses topics and skills with the residents, shares knowledge and experience, and introduces Baxter Regional specific information. The information provided enhances the RN Residents' success as it builds upon knowledge gained in nursing school. The professional development sessions enhance knowledge, promote critical thinking, and provide valuable resources for the resident to reach out to with future questions. Baxter Regional is providing workshops to support and provide training to SMEs. SME Boot Camp workshops include hands-on training to help SMEs fine-tune presentation skills to confidently present engaging, informative, and exciting sessions. Upcoming workshops for Boot Camp Basic Training are October 15th and October 26th, 2020. If you are interested in becoming an SME, just dust off your combat boots and gear up for a fun time. Registration is in TLC. Please contact Amy Myers at extension 1746 or [email protected] for more information.

Nicole Vaccarella, BRMC Legal Counsel, and James

Dabney, BSN, RN, share thoughts during SME Boot

Camp. Additional Subject Matter Experts were

participating in SME Boot Camp activities. Gear up

and join SME Boot Camp: Basic Training. Register in

TLC!

mailto:[email protected]


Trauma Team Update Angel Strain, BSN, RN Trauma Program Manager, and Stroke Coordinator and Tammy Hodges,

ADN, RN Trauma/Stroke Coordinator

Hunting Season is upon us, and Trauma Services/Cline Emergency Center wants to remind everyone to review and think about firearm safety every time you head out. Here are some basic rules of firearm safety: Treat every firearm as if it is loaded. Never assume a firearm is unloaded and never treat it that way, even if you watch as it is unloaded. Make it a habit to treat guns like they are loaded all the time. Always point the muzzle in a safe direction. About one-third of all hunting incidents are self-inflicted injuries. That means the muzzle was pointed at some part of the hunter’s body. A safe direction is a direction where the bullet will travel and harm no one in the event of an unwanted discharge. Be certain of your target and what is beyond it. Positive target identification is a must. To shoot at something you

only think is a legal target is gambling. In the case of human injury, that means gambling with human life. You must be absolutely sure and correct in judgment before deciding to shoot. Otherwise, it is reckless behavior. In addition to identifying the target, a hunter must know that a safe backstop for their bullet is present in every shooting situation. We do not always hit our target, and, in some cases, the bullet passes through the target. A safe backstop guarantees that no one will get hurt. Keep your finger outside the trigger guard until ready to shoot. If a hunter stumbles with a firearm in one hand

and nothing in the other, whatever that person does with their free hand will automatically happen with the hand holding the gun. If a finger is inside the trigger guard, that hand will likely close around the gun's pistol grip and on the trigger, causing an unwanted discharge. Planning your fall hunting trip also means having your gear in proper working order. Firearms should be cleaned and closely inspected for any signs of mechanical wear that could result in a problem in the field. BE SAFE!

Food Insecurity Jodi Bodenhamer, ADN, RN, CDCES

At BRMC, we know that healing and wellness go way beyond our doors here at the hospital. To make sure our patients always have the necessary tools needed to get well and stay well, BRMC staff consistently provides necessities for patients in need, i.e., medications, transportation, and even food. Early in 2020, The BRMC Food Insecurity Task Force began tracking food insecurity with our patients here at BRMC and working with the North Central Arkansas Food Bank to form our very own BRMC Food Pantry. With combined efforts from nursing staff, dietitians, unit directors, continuity of care, home health, community paramedics, and many others, BRMC now has a one-time food box available to give to any patient in need. This nutritious food is available through BRMC Continuity of Care (Social Work Consult), Community Paramedics, Home Health, The four Community Support Houses (Peitz, Reppell, Mruk, and Schliemann), and in the ED. After hours or in an emergent situation, BRMC staff may also call Hospital Chaplain Randy Ludwig at extension 7750 to obtain a food box for a patient. Also, BRMC Marketing has added food insecure resources (local food pantries, hot meals) to our patient information guides so that our patients can tap into other community resources as needed. Proving once again, BRMC takes care of our patients' many needs, making our hospital THE VERY BEST!


Clinic Highlight – The Pulmonology Clinic Darlene Carpenter, Manager

The Baxter Regional Medical Center (BRMC) Pulmonology Clinic recently relocated to Suite 3A in the Medical Arts Building. The Nephrology and Pulmonology Clinics had shared a clinic at Cardiovascular Associates (CVA) since 2013. Due to space and logistical issues, it was determined that a new location would help clinic staff to continue to provide the excellent care that patients expect from Baxter Regional. Dr. Martin and Dr. Malte are the providers for the Pulmonology clinic. Amanda Beyer, ADN, RN, works closely with Kelly Smith, RRT, Cathy Eickman, CRT, and Teresa Borseth, MA, in administering medical injections and ambulation of patients to assess qualification for oxygen, determining available home health services, and educating patients on pulmonary conditions. The team helps patients find financial assistance for medications and assists patients with insurance companies for reimbursement for oxygen, medications, procedures, or tests. The team handles the phone calls, rooming patients, preauthorization for medications and tests, and dealing with durable medical equipment (DME) companies for the patients. Cathy also performs pulmonary function tests (PFT’s) for the Pulmonology office, CVA, and other providers in the area. Amanda and the team coordinate care for the COVID-19 patients that come through the Emergency Room. Shelbi Chentick is Dr. Martin's scribe, and she assists with entering orders, pre-preparation of daily patients’ records, outgoing referrals, and other office tasks. Dr. Malte’s scribe should be hired this month and will be a big help to the team by doing the same as Shelbi. Patty Tate, Lynnette Haley, and Emily Dickerson are responsible for scheduling, answering phone calls, completing other office tasks, and managing the incoming referrals for Dr. Martin and Dr. Malte. Darlene Carpenter, the Clinic Manager, and the entire team strive to make sure the Pulmonology patients have the best quality care/outcomes every time they call or come into the office. Pictured left to right: Teresa Borseth, MA, Amanda Beyer, ADN, RN, and Kelly Smith, RRT

The Magnet Journey to Excellence BRMC Nursing Division Shared Governance Newsletter

Senior Editor: Barb Dyson, MSN, RN–Magnet Program Director, Director of Clinical Excellence, Nursing Administration Managing Editor: Becky McCoy, BSN, RN–Clinical Excellence Informatics Nurse, Nursing Administration Contributing Editors: 2020 Nursing Divisional Council Co-Chairs Co-Chair Practice: Hannah Blasdel, BSN, RN–Clinical Nurse ICU Co-Chair Development: Jennifer Bohrtz, BSN, RN, WCC–Inpatient Wound Nurse, Nursing Administration Co-Chair Safety/Quality: Angie Knight BSN, RN–Clinical Nurse, Family Clinic on Market Co-Chair New Knowledge & Innovation: (Open) We would love to hear from you. The Journey to Excellence newsletter is your Interprofessional newsletter. Routine sections include notes from our CNO, Stories from the Heart/Recognition, Standards Updates, Magnet, and Shared Governance Updates, and clinical topics (Nutrition, Pharmacy, etc.). Please see the following guidelines and submit articles for newsletter publication directly to the Managing Editor – Becky McCoy.

o Only electronic versions accepted o Maximum 300 words, including title, text, and references if content requires o Include your name, highest nursing degree, license & certifications o General articles write in the third person (we, our); personal stories. Use “I.” o Edit for grammar & spelling before submission; no HIPAA PHI o Take care to include text citations for all paraphrased content and quotations, and add references in APA

format for articles related to direct care clinical practice Standards o Observe the firm deadline for submission—the 10th of each month o The Editor reserves the right to approve, edit, or reject submissions.
