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2010 NURSING ANNUAL REPORT RELATIONSHIP-BASED CARE… mORE THAN ACTIONS, INTERACTIONS Transformational Leadership Structural Empowerment and Teamwork Exemplary Professional Practice New Knowledge and Innovation Empirical Quality Results 2010 NURSING ANNUAL REPORT 1 IT’S ALL ABOUT RELATIONSHIPS. How we relate to each other, our patients and our community. Relationship-Based Care Nursing at Tallahassee Memorial has adopted a model of care that provides a framework for providing excellent care through collaborative relationships. Relationship-based care takes place in a caring and healing environment organized around the needs and priorities of the patients and their families who are the center of the care team. This report highlights many examples of how our colleagues have developed strong collaborative relationships in order to achieve outstanding patient care and advance nursing practice at TMH. 2 2010 NURSING ANNUAL REPORT Tallahassee memorial HealthCare 2010 NURSING ANNUAL REPORT Transformational Leadership 2 Leading the Way in Our Vision for World Class Health Care 4 Giving Every Nurse a Voice through Shared Governance Structural Empowerment and Teamwork 6 Creating New Ways to Get Patients to the Right Place at the Right Time 8 Reaching Out to Our Community 10 Providing Resources for Professional Nursing Practice 11 Developing Collaborative Relationships to Improve Patient Care Exemplary Professional Practice 12 Bringing New Technology to Heart Attack Patients 14 Pushing the System to Improve Patient Care 16 Recognizing Nurses Who Achieve Professional Advancement New Knowledge & Innovation 18 Using Evidence-Based Practice to Help Diabetes Patients 20 Finding a New Way to Minimize the Pain of an Injection for Kids 22 Supporting Nurse Scholars 24 Spreading the Word about New Knowledge Empirical Quality Results 26 Keeping an Eye on our Progress The 2010 Nursing Annual Report is produced by the Nursing and Public Relations Departments of Tallahassee Memorial HealthCare, 1300 Miccosukee Road, Tallahassee, FL 32308. Phone (850) 431-1155. TRANSfORmATIONAL LEADERSHIP Nurses Are Leaders in Our Pursuit Of RECOGNIzED WORLD CLASS HEALTH CARE Dear TMH Friends & Colleagues: As Tallahassee Memorial HealthCare continues working toward Magnet™ recognition, I’d like to congratulate our nurses for the progress made during 2010. Clearly, nurses throughout the organization are making vital contributions as we pursue our vision of being a recognized world-class community health care system. Tallahassee Memorial has experienced many successes during the past year. As you review this annual report, you will learn how nurses have contributed significantly to these successes through their work as compassionate healers, progressive educators, innovative researchers, continuous learners, creative thinkers, valued collaborators, involved decision makers and passionate leaders. These qualities exemplify the highly skilled professional nursing practice that has developed at TMH. In my view, TMH nurses combine the art and the science of their profession and contribute to a healthy environment for our patients and our colleagues. As we look forward to a new year of challenges and opportunities, I urge our nurses, and indeed, all of our colleagues to continue the good work that has been started. Know that your efforts not only strengthen our organization, but give us the privilege of providing the best experience possible for the patients we serve. Sincerely, G. Mark O’Bryant President & CEO 2 2010 NURSING ANNUAL REPORT TRANSfORmATIONAL LEADERSHIP Nursing Excellence CONTINUES TO UNfOLD AT TmH I am pleased to welcome you to the 2010 Nursing Annual Report. There have been many successes during the past year and it is a privilege to describe the efforts that TMH nurses and their colleagues have put forth to create the outcomes that have occurred. The successes will be profiled within the framework of the American Nurses Credentialing Center’s Magnet™ Model but will be shared via stories of the relationships between nurses, patients, peers and colleagues across TMH and across our community. I would like to commend you, our nurses, for strengthening our organization through relentless pursuit of nursing excellence. You have continually advanced the professionalism and image of nursing. You have organized and participated in sound decision making, supported by science, evidence and experience. You have managed our resources through stewardship. You have maintained a focus on improving communication, systems and processes to enhance the quality of care we provide for our patients. We continue to strive to ensure every patient and family member truly feels that we care and that our passion is for service. You will read about your amazing year. You will be touched by stories that you didn’t know existed in your midst. Each of you has helped to advance the mission and vision of Tallahassee Memorial. Be proud and accept my gratitude for your dedication and excellence. Sincerely, Barbara Gill MacArthur, RN, MN, FAAN Vice President & Chief Nursing Officer 2010 NURSING ANNUAL REPORT 3 TRANSfORmATIONAL LEADERSHIP THE COOrdiNATiNg COuNCiL iNCLudEs THE CHAirs Of EACH Of THE fivE sHArEd gOvErNANCE COuNCiLs (Quality, Education, Practice, Management and research & Evidence-Based Practice Advancement) as well as other TMH nursing leaders. Pictured here are members (front to back) Jessica Bahorski, ArNP, MsN, Leslie Hancock, rN, MN, susan King, ArNP, MsN, and Norman Pasley, rN, MsN. (Not all Council members are included.) The Quest for mAGNET RECOGNITION Tallahassee Memorial is pursuing Magnet ™ recognition, a designation Magnet hospitals are known across the country as being the place conferred by the American Nurses Credentialing Center (ANCC) where the best nurses practice. Research has indicated that the time when a health care organization has demonstrated that it provides spent on the journey to Magnet recognition strengthens the quality of an environment of excellence in nursing care. Achieving Magnet nursing practice and patient care. recognition requires successfully completing a rigorous multi-year process that qualifies the organization for submission of an application. The Five Magnet Model Components The decision to pursue Magnet recognition represents a major • Transformational Leadership • Structural Empowerment commitment by the organization. It communicates that we place the • Exemplary Professional Practice highest priority on providing quality care for our patients and a positive • New Knowledge, Innovation & Improvements proactive environment for our colleagues. • Empirical Quality Results 4 2010 NURSING ANNUAL REPORT TRANSfORmATIONAL LEADERSHIP shared governance The Voice of NursiNg aT TMh Message from Sheri Cook, RN Chair of the Shared Governance Coordinating Council WhaT IS ShaREd GovERNaNCE? 1 It is the nurse’s voice being heard at every level throughout the organization. 2 It is about relationships. 3 It is making every nurse the “best in role” through this collaborative effort. Shared Governance is the voice of nursing at Tallahassee Memorial Role modeling and mentoring of rising leaders occurs. Alignment Hospital. “The appropriate use of voice is, therefore, not a threat either to of nursing with the TMH strategic plan, via this group, provides the nurses or to nursing. Silence is the threat to nursing. Nursing recognition opportunity to make progress toward becoming a recognized world- hinges on individual nurses using their voice.” (Bruesh, 2006, p. 29) class hospital with MagnetTM recognition. As the co-chair, along with the Chief Nursing Officer, of the Coordinating Council, I interface As we have seen again and again, we are using our collective voice to both vertically and horizontally with colleagues, and I am present directly affect our patients’ outcomes with best practices in care. On at meetings with members of the Board of Directors. The Shared every nursing unit there are education, practice, quality and research Governance model clearly provides representation to and from nursing teams. These unit-based teams are led by nurses who are directly throughout the organization. involved in patient care and have chosen to join these teams to improve processes and measurable outcomes. Each nursing unit elects Shared Governance is about collaboration. Being elected to represent representatives to hospital-wide councils that address concerns and the best in nursing is an honor and a reminder of the value of formulate strategies for improvement and the application of evidence- relationships. We are called to lead, teach and advocate for our based practices throughout TMH. patients and our communities. As we serve, we must obtain the best tools and information available. Then, our patients will receive the Each of the house-wide councils is led by an elected chair, who serves best of care as we work together. Collectively we are stronger, smarter as a member of the Coordinating Council. The Coordinating Council is and superior. Thanks to all who give us the opportunity to grow, more than a representative body carrying forward the voice of nursing. becoming better and wiser nurses in this process. The Council is about relationships. The Coordinating Council includes the Vice President/Chief Nursing Officer, the Executive Director of Bruesh, B., Gordon, S. (2006) From Silence to Voice, what nurses know Nursing Operations, the Directors of Nursing Practice and Clinical and must communicate to the public, ILR Press London. Education, and the Magnet Program Manager. 2010 NURSING ANNUAL REPORT 5 STRUCTURAL EmPOWERmENT & TEAmWORK duriNg A dAiLy BEd HuddLE, nursing leaders utilize an electronic system to determine the status of every patient in the hospital in order to help with timely placement of newly arriving patients. 6 2010 NURSING ANNUAL REPORT STRUCTURAL EmPOWERmENT & TEAmWORK smooth operators The Many Components of Nursing Operations Help Keep Patient Care on Track at TMH On average, Tallahassee Memorial Hospital sees 400-600 patients per day. who make our hospital’s electronic tools effective. “Our colleagues did an Getting each of those patients to the right place and making sure every area outstanding job of adapting to this change,” she commends. of the hospital is staffed with enough nurses to provide care is a big job. In addition to making use of these technological advancements, TMH Fortunately, strong leadership, advanced technology and a cooperative colleagues have an active and vital role in shaping our hospital’s Nursing team of nursing colleagues enable our hospital to meet the challenge every Operations. Each month, an interdisciplinary team called the house-wide day. The term “Nursing Operations” encompasses the wide range of people, Patient Flow Committee meets to review systems and data and determine programs and protocols involved in this task. where improvements can be made. In September 2009, TMH developed a shared staffing policy that eases patient flow by identifying nurses who ” Over the years, our system of Nursing Operations has undergone many have the ability to work in multiple units. changes, creating marked improvements in the efficiency and level of care our hospital provides. Norman Pasley, RN, MSN, Director of Patient Flow, cites the implementation of electronic tools as the greatest improvements Electronic tools promote clinical in patient flow he has observed during his time at TMH. “Electronic tools readiness by helping our nurses to promote clinical readiness by helping our nurses to plan and prepare,” he says. “When a patient is discharged or transferred to the proper setting faster, plan and prepare. — Norman Pasley, RN, MSN patient satisfaction improves.” This policy delineates all nursing competencies and the units where OptiLinkTM is an automated tool that helps manage scheduling, and specialized care takes place. By identifying competencies among nursing TeleTracking is a collection of electronic tools designed to manage patient staff, we determine which nurses are eligible to work in units outside of traffic and bed allocation within the hospital. While TMH began utilizing their home units. This way, when one unit is “surging” in patient volume or electronic tools as early as 2002, the most recent addition is an electronic has a staff member call out sick, a nurse from another unit can help to fill in Bed Board acquired in April 2009. those gaps. Prior to the Bed Board, phone calls were made to a number of hospital Ultimately, the many components of Nursing Operations, now located in a units every time a patient needed to be assigned to a bed. Now, colleagues centralized area, converge to help our staff provide the highest quality of in the Patient Placement department can view the status of all the beds in care for our patients. Streamlining our methods of operation in order to the hospital on a flat screen television set. Based on the information they deliver this quality of care is a process that involves many people including observe, they can assign patients to available beds electronically. The system nursing supervisors, the central staffing office, float pool colleagues, the then automatically notifies nursing units of pending arrivals via pager. patient transportation department, and our patient placement staff. As This process has markedly decreased the number of phone calls needed to our team continues to work cohesively, and technology steadily improves, make bed assignments and has resulted in a 60% reduction in the time it Nursing Operations will also continue to strengthen our ability to care for takes to get a patient placed on the appropriate nursing unit. patients. “We use our resources better than we ever used to. This isn’t just a tool. We “We’re right up there with any hospital, but we’re implementing the changed our whole process. Now we can be prepared and proactive. We can methods to be among the best,” says Norman. “It is just a matter of plan,” says Lori Knarr, RN, MS, and Executive Director of Nursing Operations. continuing to secure the tools and technology to deliver world-class care.” While Lori recognizes the significant role of technology in improving Nursing Operations, she is also quick to point out that it is TMH colleagues 2010 NURSING ANNUAL REPORT 7 STRUCTURAL EmPOWERmENT & TEAmWORK TMH Nurses reach ouT To The coMMuNiTY The dedication of TMH nurses extends beyond the hospital’s walls with our colleagues volunteering their time to dozens of not-for-profit organizations throughout the year in order to help improve the health of our community. It is with pride that we acknowledge some of the volunteer activities that our nurses participated in during 2010. Automated External Defibrillator training for state park employees Influenza Clinic for Imagine School at Evening Rose Automated External Defibrillator training at a local church Leon County Annual Health Fair Alzheimer’s Project at a local church Leon County Emergency Medical Services Kids Fair American Cancer Society Relay For Life Making Strides Against Breast Cancer Walk American Heart Association Walk March of Dimes Walk Backstage RN for drama production at a local high school MRSA presentation at a local church Bowling for Diabetes fund-raiser NAMI (National Alliance on Mental Illness) Walk Boy Scouts of America Nurse coordinator at the Florida Camp for Children and Youth with Diabetes Camp nurse at Florida Bible Camp Pregnancy Help Center Cardiovascular disease presentation at a local church Preschool health habits presentation at a local school Clinic nurse at Boy scout Camp Wallwood Project Graduation with local high school Community health fair for Big Bend Black Nurses Association Ride for Hope to benefit Tallahassee Memorial Cancer Center Community outreach at Temple Maintenance, a local church Tallahassee Tennis Challenger to benefit the Vogter Neuro ICU Disaster relief with the Florida Baptist Association First aid responder at youth camp Forget Me Not Walk for Alzheimer Disease Healthy Living Team, Elder Care Program 8 2010 NURSING ANNUAL REPORT STRUCTURAL EmPOWERmENT & TEAmWORK sOME Of THE COLLEAguEs frOM THE TMH OPErATiNg rOOM who called their team the Heart Bypassers raised money for the American Heart Association’s 2010 Heart Walk. Pictured are: Alyssa Litton, rN, danielle verity, rN, Kelly Wiley, certified surgical technologist, and Tricia folsom, rN, BsN. (Not all team members are pictured.) 2010 NURSING ANNUAL REPORT 9 STRUCTURAL EmPOWERmENT & TEAmWORK Nursing Resource Center Named for former TMH Chief Nursing Officer In July 2010, approximately 100 people gathered at TMH to pay tribute to former Chief Nursing Officer, Joan Futch, at a ceremony to name the Nursing Resource Center in her honor. Joan, who was present at the ceremony, passed away in March 2011. Joan Futch, RN, BSN, MSHA, began working as a staff nurse at TMH in 1969. As a result of her outstanding performance and professionalism, she progressed through the organization to Senior Vice President for Nursing Administration & Chief Nursing Officer in 1986 and held that position until her retirement in 2001. The Joan R. Futch Nursing Resource Center helps advance the nursing profession at TMH by promoting the continuous learning necessary to provide the very best of care to our patients and families. It is an educational environment where nurses can network, conduct literature searches of current publications and research findings, and consult with Roxanne Hauber, RN, PhD., a faculty member of the Florida State University College of Nursing and the first nurse researcher for the Nurse Scientist Scholar Program at Tallahassee Memorial. (See related article on page 22.) Joan stated during the ceremony, “I am proud to have been given the opportunity to serve at TMH for so many decades. We accomplished much while I was here, but there is still much to be done. I have seen what is occurring with nursing practice at TMH today and I salute the nurses and the leadership at TMH responsible for this. Please use this resource center to keep up the good work.” As a further tribute to Joan, the TMH Foundation has established the Joan R. disPLAyiNg THE PLAQuE uNvEiLEd AT THE dEdiCATiON Of Futch Nursing Resource Fund for continuing education, travel, equipment and THE JOAN r. fuTCH rEsOurCE CENTEr ON JuLy 18, 2010 other endeavors and acquisitions that will assist nurses in meeting present are: (left to right) Paula fortunas, President and Chief Executive and future challenges. For donation information, visit Officer of the TMH foundation, Joan futch, rN, former TMH Chief www.tmhfoundation.org or call (850) 431-5389. Nursing Officer, and Barbara MacArthur, rN, MN, fAAN, current TMH vice President/Chief Nursing Officer. 10 2010 NURSING ANNUAL REPORT STRUCTURAL EmPOWERmENT & TEAmWORK collaborative relationships advance Patient care Just as it takes a village to raise a child, nurses at Tallahassee Memorial know that their work is enhanced and supported by their colleagues from many different disciplines within the organization. These collaborative working relationships are based on the premise that all members of the healthcare team make essential and meaningful contributions in the achievement of clinical outcomes. “If it is one of us, it is all of us,” states Barbara MacArthur, Vice President/Chief Nursing Officer. To recognize these relationships, the Nursing Departments salutes a group of “Featured Colleagues” in each issue of its monthly employee newsletter called Pulse. Sometimes, the group of “Featured Colleagues” includes nurses and sometimes it does not, but the “Featured Colleagues” are always valued members of the health care team at TMH. CiNdy ALLEN ANd TiM fOrTuNAs ArE PArT Of THE PATiENT AdvOCACy One such group is the Patient Advocacy Department. Some of TEAM that interacts with nurses and other TMH colleagues to enhance the experi- their activities include: ence of patients and family members at the hospital. n Visiting patients on the inpatient units. n Researching and providing appropriate information to patients and families. n Supporting families in crisis during medical emergencies and in ongoing hospitalization. n Partnering with staff to resolve concerns voiced by patients, improve communications and help meet non-clinical patient and family needs. n Providing information to out-of- town friends and family members about hotels, meals and transportation. n Handing out patient safety information and supplying personal items. n Recognizing patients who celebrate their birthdays while hospitalized. 2010 NURSING ANNUAL REPORT 11 EXEmPLARY PROfESSIONAL PRACTICE TMH Nurses Lead the Way With cooL New Technology In August 2009, TMH became the first hospital in the Big Bend to Russ Marsh, 59, a local man who has made a full recovery after being implement the use of therapeutic hypothermia treatment for heart treated at TMH for a heart attack last year. “I think cooling therapy is attack victims. The lifesaving treatment lowers body temperature a great thing based on the wonders it has done for us,” says his wife in order to preserve brain function following cardiac arrest, and our Diane. “I don’t think he would be the way he is now if TMH hadn’t nurses were directly responsible for bringing this technology to TMH. used this technology,” she adds. Ally Fields, RN, BSN was serving as Assistant Nurse Manager in the Approximately 2-3 patients are being treated with therapeutic Bixler Emergency Center when she first learned of the treatment and hypothermia per month at TMH. Usually the therapy is initiated in the contacted Benjamin Abella, MD, of the University of Pennsylvania, Emergency Center, Diagnostic and Interventional Suite (Cath Lab) or “ a national leader in resuscitation research. Cardiac Intensive Care Unit (CICU). Regardless of where the treatment is initiated, therapeutic hypothermia care continues as the patient There’s always an environment of caution progresses through many units within the hospital, and successful when you start a new therapy, but now treatment is made possible by the joint efforts of many colleagues. we are seeing the neurological benefits “This is a really strong collaboration between our physicians and our for our patients. —Ally Fields, RN, BSN nurses,” commends Ally. Dr. Abella readily collaborated with Fields, and another nursing The latest undertaking of Ally and the TMH team, has been involving colleague, Terri Repasky, RN, MSN, in order to create a cooling local paramedics and the Leon County Emergency Medical Services treatment protocol for TMH. Ultimately, nurses developed a thorough in this lifesaving therapy by providing education. TMH nurses are and highly effective protocol, and now all TMH critical care nurses— more than willing to share their skills, knowledge and commitment to just over 100 individuals—have been educated in cooling therapy. health and positive outcomes with our community via this therapeutic Over the past year and a half, the program has grown exponentially, advancement. reaching success rates equivalent to or greater than many institutions Ally, who now works as a nurse in the Cardiovascular Medical-Surgical across the nation. “There’s always an environment of caution when Intensive Care Unit, connects her passion for therapeutic hypothermia you start a new therapy, but now we are seeing the neurological treatment to the painful experience of losing her father to cardiac benefits for our patients,” says Ally. “Bringing this technology to the arrest when she was a teenager. “He would have survived if not for area is just one more example of the world-class care we provide at the loss of brain function,” she says. “I’ve always wanted to help TMH.” prevent others from going through what my family went through.” Many cardiac arrest patients who might have otherwise died or The adoption of therapeutic hypothermia treatment at TMH is a experienced severe neurological outcomes have been able to return testament to the vision and dedication of our nurses, as well as the to their normal lives thanks to this treatment. One such patient is strong support of our physicians and colleagues. 12 2010 NURSING ANNUAL REPORT EXEmPLARY PROfESSIONAL PRACTICE ALLy fiELds, rN, BsN, WAs iNsTruMENTAL in bringing therapeutic hypothermia treatment to TMH, a technology that helps preserve brain function in certain types of heart attack victims. 2010 NURSING ANNUAL REPORT 13 EXEmPLARY PROfESSIONAL PRACTICE Clinical specialists: Advanced Practice Nurses Who Push the system to improve Patient care Most people know what a nurse practitioner is. The same can be said technology. Once a final selection was made, a whole host of changes for nurse midwives and nurse anesthetists. But when people hear the had to occur, involving many different departments, to prepare TMH title “clinical specialist,” they look confused and ask “what do you do, for the introduction of smart pumps. Policies and procedures had to exactly?” be written to reflect new science and technology. Physician order set changes and education for approximately 925 nurses took place. The Kathy Barnett, RN, MSN, Pain Management Clinical Specialist at TMH, education was accomplished with the assistance of the TMH Clinical understands the confusion. “We wear many hats, and cover a lot Education faculty and utilized web-based learning and hands-on of territory,” Kathy explains. Clinical specialists are registered nurses competency validation. Kathy also communicated with the Pharmacy with an advanced degree who serve as clinical experts, educators, ” & Therapeutics Committee of the Medical Staff who provided input to researchers, consultants and managers in their area of expertise. Currently TMH is home to five of them (in pain management, emergency, cardiovascular, pediatrics and maternal-child). On any after implementation, I went out and given day, you might find a clinical specialist at a patient’s bedside, in talked to users about smart pumps and the classroom, in a committee meeting or online reviewing the latest heard only three things: It’s so much easier. research on a patient care issue. “Our job is to push the system to It’s so much better. It’s so much safer. improve patient care in our specialty, and that can take us in a lot — Kathy Barnett, RN, MSN of directions.” establish safe, effective drug dosage libraries that were programmed A significant contribution by a clinical specialist at TMH was the into the pumps. Implementation occurred in March 2009 and went advent of ‘smart’ pump technology for the IV administration of patient off without a hitch. Kathy adds, “After implementation, I went out and controlled analgesia (PCA). By keeping eyes and ears on evidence- talked to users about smart pumps and heard only three things: ‘It’s so based practices, it became apparent that smart pumps were totally much easier. It’s so much better. It’s so much safer.’ That tells me that in keeping with TMH’s vision of providing recognized world-class we did a good job planning. We chose a good product, we anticipated health care. Kathy gathered the evidence and then worked through potential problems upfront, and we listened to our staff all along administrative channels to create a business plan for how the pumps the way.” Over the last year, additional applications and uses of the would benefit the organization and the patients that it serves. Dollars technology have been added. were allocated through the organization-wide capital equipment Today, the built-in safeguards of smart pump technology have budgeting process. dramatically increased patient safety at TMH, virtually eliminating PCA “Then we had to move from vision to reality,” Kathy says. Onsite programming errors. This fact never fails to make Kathy smile. “That demonstrations of the pumps available on the market took place to alone is worth its weight in gold,” she says. garner input from the clinical, bedside nurses who would use the 14 2010 NURSING ANNUAL REPORT EXEmPLARY PROfESSIONAL PRACTICE CLiNiCAL sPECiALisT KATHy BArNETT, rN, Ms, (middle) worked with colleagues in many different disciplines at TMH to implement smart pump technology for iv administration of patient controlled analgesia (PCA) for pain management. she is pictured here with Hematologist/Oncologist Tim Broeseker, Md, and iT Project Manager Walt Colville.15 2010 NURSING ANNUAL REPORT EXEmPLARY PROfESSIONAL PRACTICE Nursing advancement at TMh TMH actively supports nursing advancement by recognizing and rewarding achievement through education differentials, certification differentials and a professional development compensation system. Currently, more than 200 nurses hold one or more specialty nursing certifications or advanced practice licensure. Advanced Registered Certified Nurse Midwife Certified Case Manager Smith, Sharon O’Neill, Shannon Nurse Practitioner Canter, Margaret Flores, Leann Stadler, Patti Perny, Cynthia Bahorski, Jessica Gurniak, Miriam Harper, Marilyn Stallard, Jacqueline Pope Jr, Stevey Benham, Nancy Hartley, Kathy Kelly, Kris Townley, Amy Roddenberry, Becton Bruner, Teressa McKeon, Kathleen Petersen, Margaret Varella, Debra Stadler, Patti Chamberlain, Melissa Ruscher, Donna Williams, Jacqueline Weeks, Barbara Stoltzfus, Esther Doheny, Laura Stroh, Heather Williams, Marylu Earp, Jaibun Certified Critical Care RN Certified Epley, Deanna Clinical Nurse Specialist Akkarappuram, Anto Certified Diabetes Gastroenterology RN Evans, Cyndi Florence, Donna Ashley, James Educator Baker, Ann-Marie Godbey, Joyce McGowan-Repasky, Terri Baker, Colleen Fevrier, Linda Dewar, Adele Griffin Jimmie Schall, Mary Beth Berry, Ivette Mitchell, Adela Fletcher, Phyllis. Griffin, Judy Brown, Laura Hammond, Jeanette Heburn, Donna Clinical Specialist Burtch, Mary Certified Dialysis Nurse Hancock, Leslee Jones, Faith Bahorski, Jessica Cantrell, Kristin Culbertson, Kathy NeSmith, Darinda King, Susan Barnett, Kathleen Cenedella, Nancy Harris, Linda Kleynen, Judy Hubmann, Monica Chason, Kelly Parker, Judith Certified HIPAA Lammert, Cartier Lee , Kathy Cochran, Maria Unglaub, Vanessa Privacy Expert Louvaris, Kathy Nicoll, Deborah Cochran, Tommy Dykes, Kelly Marky, Angie Collins, Amanda Certified Moore, Vivian Certified Ambulatory Fields, Ally Emergency Nurse Certified Hospice Nash, Beth Care Nurse Forrest, Linda Aggabao, Gloria & Palliative Care Nurse Pallentino, Julia Atteberry, Mary Griscom, Wendy Barton, Cheryl Grischy, Sandy Patterson, Kathy Cooper, Claudia Harrison, Lesley Cook, Sheri Pedersen, Debra Copeland, Deborah Jordan, Elizabeth Doud, Victoria Certified in Infection Randall, Sara Dodson, Barbara Loftis, Darlene Fields, Jennifer Prevention and Control Spells, Melanie Hatcher, Patricia Matyjaszek, Jeremy Godwin, Joni Benham, Nancy Steele, Lynn Jubinsky, Christine Mavridoglou, Petros Hadden, Kelli Kelly, Wallace Stevens, Michelle Turner, Julie McDonald, Erica Hedrick, Jayne Whaley, Quandra Wester, Julia O’Neill-Wann, Robin Kelly, Cynthia Certified Inpatient Wilson, Irene Whittington, London Patterson, Kathryn McCallister, Debra OB Nurse Wright, Margaret Plasay, Rebecca McGowan-Repasky, Terri Amirzadeh Asl, Parivash Sapp, Johnnie Meals, Kimberly Bailey, Laurentina 16 2010 NURSING ANNUAL REPORT EXEmPLARY PROfESSIONAL PRACTICE Brannen, Nancy Manzo, Girlie Picklesimer, Diana Lewis, Nancy Minimum Data Set Cao, Kimberly Powell, Angela Russell, Linda Lonkani, Sharon /PPS/RAI Chaney, Traci Robinson, Lydia Sowell, Cheryl Newman, Katie Hevner, Mylinda Dewit, Sharon Smith, Deborah Sutton, Karen Taylor, Sonseria Wilson, Faye Kelly, Victoria Tomberlin, Herbert Swoboda, Debora Whitaker, Linda Kirkland, Stephanie Williams, Tarika Tricquet, Pamela Nurse Executive Marcinowski, Kendra White, Anne Certified Radiologic Nurse Lyon, Freda McGee, Eileen Certified Neonatal Ward, Ashley Knarr, Lori Nichols, Paula Intensive Care Nurse Certified Pediatric Nurse Pasley, Norman Roberts, Erin Bloyd, Kim Buser, Eileen Certified Rehab RN Rohe, Karen Booker, Cynthia English, Ashley Evans, Shiela Nursing Professional Tiller, Heidi Driver, Emily Gatlin, Sherry Williams, Jacqueline Development Forbes, Stacie Glady, Robin Maxwell, Karen Certified Lactation Glombowski, Kathy Lewis, Suzanne Certified RN Consultant Merritt, Deborah Long, Monique Assessment Coordinator Oncology Certified Nurse Chavers, Heidi Schrader, Petrea Marr, Denise Wilson, Faye Carson, Jessica Comer, Christina Spataro, Sharon Paterniti, Crystal Garrigan, Annette Frazier, Shelly Stevens, Teresa Pierce, Karen Certified RN, Infusion Marky, Angela Goodson, Angela Tucker, Monica Ranner, Donna Hoch, Nora Michaels, Joanne Miller, Elizabeth White, Lalania Reiser, Linda Murphy, Frances Zampino, Sheryl Williams, Louisa Certified Sexual Assault Robertson, Christina Certified Maternal Nurse Examiner Taylor, Dreama Newborn Nurse Certified Certified Walker, Kathy Van Winkle, Shannon Brock, Mary Neuroscience RN Post Anesthesia Nurse Dixon, Sandra Howard, Meredith Brown, Gail Certified - Wound Care Johnson, Jennifer Schremser, Christie Brown, Madelyn Moran, Gisela Progressive Care Katz, Linda Soike, Kevin M. McCarthy, Kate Certified RN Peterson, Tasha Teems, Nancy Certified Wound Ostomy Barden, Leanne Certified Professional in Nurse Cain, Grace Certified Med-Surg Nurse Certified Nurse Health Care Quality Payne, Jennifer Corbin, Keith Asis-Cruz, Katherine Operating Room Monica Ford-Green Gaden, Karen Banes-Egina, Mary Jane Barfield, LeeAnn Lamaze Certified Holland, Diana Baptista, Girlie Blanton, Jane Certified Psychiatric/ Childbirth Educator Paulett, Christina Buckhalter, Harriet Coldwell, Angie Mental Health Nurse Tafuri, Kathleen Reynolds, Julie Burnett, Rebecca Duckett, Faith Baillargeon-Chaloux, Shipp, Kimberly Cooper, Barbara Folsom, Patricia Donna Medical-Surgical RN, Solis, Sharon Deabler, Susan Howes, Kathy Baker, Shirlene Board-Certified Wiler, Zahma Groce-Madison, Mary Ingram, Sharon Bowles, Pamela Groce-Madison, Mary Hamilton, Pamela Jackson, Sharon Carter, Sandra Higham, Sandra Johnson, Joyce Chambers, Linda Linsagan, Nell Jasmine Linton, Alyssa DeCastro, Arlene 2010 NURSING ANNUAL REPORT 17 NEW KNOWLEDGE & INNOvATION AdELA MiTCHELL, rN, Of THE TALLAHAssEE MEMOriAL diABETEs CENTEr shows Heath Plair of Port st. Joe how an insulin pump works. Adela completed an Evidence-Based Practice (EPB) study that compared the effectiveness of insulin pump therapy and multiple injections for controlling blood sugars in pediatric diabetes patients. 18 2010 NURSING ANNUAL REPORT NEW KNOWLEDGE & INNOvATION Diabetes Nurse finds Answers to Questions About Effectiveness of insulin Pump Therapy using Evidence-Based Practice Adela Mitchell, RN, spends her days as a certified diabetes educator at the After an exhaustive search of research databases, Adela found seven Tallahassee Memorial Diabetes Center providing care, education and support studies that met her criteria. The research criteria were: good design, to adults and children with diabetes and their families. One of the common more randomized studies, population with patients that were between questions she is asked by parents of children with type 1 diabetes is, “Would the ages of 1 and 21 years, and research not conducted by companies that we be able to control our child’s blood sugar better with an insulin pump manufactured insulin pumps. than with injections?” After evaluating and synthesizing the data, Adela was able to summarize her “There are pros and cons to insulin pump therapy” explains Adela. “It does findings: allow a lot more flexibility with meals and snacks, but some children do not like to be attached to it all the time. Most children on insulin pumps like the n A1C levels (a measurement of a person’s average blood sugar levels over a fact that they do not have to take several injections a day, but the insertion period of months), was lower (better) for insulin pumps in only one short sets have to be changed every three days and they can get clogged at times. study. Longer studies showed no significant difference. It’s not for everyone, so when parents ask if they should get a pump, I want n Three of the studies showed less episodes of severe hypoglycemia (low to provide an appropriate answer.” blood sugar) in those with insulin pumps, but the consensus was that Until she went through Evidence-Based Practice (EBP) Mentor training more controlled studies were needed. at Tallahassee Memorial, Adela would cite her personal observations, n One study showed a higher rate of diabetic ketoacidosis (DKA) or information she learned at conferences or articles she had read. The EBP increased ketone production with insulin pumps, but none that required Mentor training she participated in during 2010 showed her a new way to hospitalization, while another study showed significantly lower episodes answer this question. It showed her how to find, synthesize and evaluate of DKA with insulin pumps. The conclusion was that more randomized research findings to answer clinical questions with more confidence. studies are needed. Adela and 13 TMH nurses met approximately twice a month over the n Insulin pumps were associated with increased treatment satisfaction course of a year and learned how to apply the steps involved in evidence- and quality of life in all studies except one, which reported no significant based practice. They also learned how to implement results within the difference. organizational framework of TMH. In addition, the nurses began working on evidence-based projects in their specific area of specialization. Adela has shared her results with the other diabetes educators at the Diabetes Center, as well as the local pediatric endocrinologists, and she is “The steps of evidence-based practice include: identifying the idea or now armed with evidenced-based information she can share with parents. question, searching the available evidence, evaluating the evidence and then She feels good knowing that what she learned through EBP Mentoring is determining how to implement the findings, “ explains Jessica Bahorski, benefiting her own patients and the local diabetes community. ARNP, MSN, the Clinical Specialist in the Pediatric Department at TMH who helped lead the EBP mentoring sessions. “The EBP Mentor training was a really good learning experience,” Adela says. “It definitely changed the way I see and research things. It showed me how Adela’s question was: How is diabetes management affected when children to look beyond my own experiences, identify appropriate research studies with diabetes use insulin pump therapy instead of multiple daily injections? and use the evidence to provide the best care I can.” 2010 NURSING ANNUAL REPORT 19 NEW KNOWLEDGE & INNOvATION AfTEr LEArNiNg ABOuT “Buzzy” AT A NursiNg CONfErENCE, donna ranner, rN, of the Pediatric department, brought this kid-friendly device that minimizes the pain of needle sticks back to TMH. she is pictured here with shelby sloan of Tallahassee. 20 2010 NURSING ANNUAL REPORT NEW KNOWLEDGE & INNOvATION shot-soother creates a Buzz in the TMh Pediatric unit At the Society of Pediatric Nurses Conference last year, Donna Ranner, RN, Certified Pediatric The science Behind Buzzy Nurse (CPN), discovered Buzzy®, a cute, kid-friendly device that reduces the pain of needle pricks. Buzzy® is based on the Gate Control Invented by a physician and mother, the vibrating plastic bumblebee with ice pack wings helps minimize discomfort and create a distraction during children’s shots. Theory of Pain, a concept introduced by Ronald melzack and Patrick Wall Donna is Chair of the Pediatric Nursing Department’s Research and Evidence-Based Shared in the 1960s. The theory proposes Governance team. Together, the team, which also includes Catherine Hanks, RN, CPN, Becky Robertson, RN, Betsy Stoutamire, RN and Nique Long, RN, CPN, decided to test the unusual that pain signals can be blocked from gadget. They used Buzzy on about 20 patients to see what the patients, parents and nurses entering the brain if alternate sensations thought. travel the same neurological pathway One of these parents was Kristen Sloan who brought her 9 year-old daughter Shelby to TMH simultaneously. when she began having symptoms of a ruptured appendix. After being admitted to the hospital, Shelby needed an IV but was very frightened. The idea is that heat, cold, pressure or vibration applied to a mild injury can “Shelby was terrified of getting an IV,” remembers Kristen, who says her daughter became even diminish pain by occupying the more upset when she learned she would also need to have blood drawn. At this point, a TMH colleague brought in Buzzy. sensory nerves. This theory is applied in many With her attention focused on the fun gadget, Shelby’s fears subsided, allowing her nurses to administer care in a supportive and compassionate way. Kristen says she would definitely request common responses Buzzy again for her daughter, as well as recommend it to other parents of young children. “It to pain, such really helped to keep her mind off of the needle,” she said. as running a Other parents who witnessed Buzzy in action were equally impressed, commenting, “Really burn under cold loved Buzzy, —He’s a big help,” and, “Loved Buzzy. My child didn’t want to give him back!” water or applying With such positive feedback, TMH quickly integrated Buzzy into children’s care in the Pediatric pressure to a Unit, Pediatric Intensive Care Unit and Kid’s Korner. Now, our nurses’ goal is to determine the bumped elbow. best techniques for utilizing the device. In December 2010, the team decided to embark on a research study using Buzzy. This new study will compare the effectiveness of Buzzy with and without his ice pack wings, as well as with a topical numbing cream. 2010 NURSING ANNUAL REPORT 21 NEW KNOWLEDGE & INNOvATION TmH Nurses Get Care Down to a Science Nurse scientist scholar Program facilitates Nursing Practice improvement Through Evidence-Based Practice and research Evidence-Based Medicine (EBM) aims to apply evidence gained from the Since the inception of the Nurse Scientist Scholar Program in 2009, TMH scientific method to clinical decision making. Examples of EBM can be nurses have engaged in a number of valuable research and evidence- traced as far back as ancient Greece. However, it was only in the 20th based projects. Examples of some recent and ongoing projects include century that the concept evolved to impact almost all fields of health care the following: and policy. n Kathy Barnett, RN, MSN, a clinical specialist, is leading an evidence- The modern day era of EBM began in the 1970s and has become the based practice project conceived by the nursing staff of the predominant approach to improving health care and patient outcomes. Postoperative Care Unit and aimed at improving their patients’ post- Subsequently, nursing began to transition to Evidence-Based Practice operative experience and pain management through pre-operative (EBP), most notably through the work of Bernadette Melnyk and Ellen patient education. Fineout-Overholt. Nursing involvement in EBP and research aimed at continuously improving nursing care is an essential component of n donna Florence, RN, MS, a clinical nurse specialist, is facilitating a team achieving MagnetTM recognition, a goal TMH has set out to achieve. from the Family Care Unit focused on mitigating an uncomfortable side effect of an epidural medication often experienced by patients. Roxanne Hauber, RN, PhD., a faculty member of the Florida State University College of Nursing, is the first nurse researcher for the Nurse n donna Ranner, RN, a certified pediatric nurse, and Jessica Bahorski, Scientist Scholar Program at Tallahassee Memorial. A partnership RN, MSN, a clinical specialist, are leading a team of Pediatric between TMH and the FSU College of Nursing, the program was Department nurses and are developing a research study to investigate established through the Florida State University and TMH foundations. what interventions are most effective for decreasing pain and distress “This collaborative initiative creates a culture of inquiry between the two associated with giving children IVs. institutions, fostering the development of nursing unit-based research n adela Mitchell, RN, a certified diabetes educator, completed an EBP and evidenced-based projects,” says Paula Fortunas, President and Chief project to discover best practices related to helping children with type I Executive Officer of the TMH Foundation. diabetes and their families make decisions about how to manage their “My job here is to facilitate the nursing staff at all levels to take insulin administration. ownership of and improve nursing practice through the use of best n Joann Green, RN, MSN, a clinical education coordinator, is evidence and when needed, the development of new knowledge,” says implementing an EBP based program focused on the nurses who serve Dr. Hauber. as clinical preceptors for new TMH colleagues. Using evidence to guide Working with Dr. Hauber to further this goal is a team of advanced the educational preparation for preceptors as well as providing support practice nurses and research council members. These nurses focus to the preceptors, best practices have been established for the unit on gaining the skills needed to access evidence and answer clinical specific orientation process. questions. 22 2010 NURSING ANNUAL REPORT NEW KNOWLEDGE & INNOvATION n deb Nicoll, RN, MSN, a clinical specialist, and Susan King, ARNP, MSN, rOxANNE HAuBEr, rN, Phd, is a faculty member at the fsu College Director of Clinical and Patient Education, have facilitated a multi- of Nursing and the first nurse researcher for the Nurse scientist scholar disciplinary EBP based project on Glycemic Control. This project Program at Tallahassee Memorial, a partnership between TMH and the addresses the management of hyperglycemia in adult inpatients fsu College of Nursing, which was established through the TMH and at TMH. fsu foundations. With each of these projects, TMH nurses make discoveries that directly practice. “The movement toward Magnet status has a strong focus improve care for our patients. Their involvement in improving patient on the role of the nurse in improving practice, which translates into care through the application of evidence and research helps establish improved patient outcomes,” points out Dr. Hauber. a nursing culture worthy of Magnet recognition, an award given by the American Nurses’ Credentialing Center (ANCC) that signifies quality patient care, nursing excellence, and innovations in professional nursing 2010 NURSING ANNUAL REPORT 23 NEW KNOWLEDGE & INNOvATION Publications and Presentations Information is best when it is shared; best practices can benefit more than the original source and one of the highest levels of responsibility for the nursing professional is to disseminate what is learned and discovered. TMH nurses are involved in sharing their work through both publications and presentations. Examples of this work are listed below and illustrate the wide variety of topics being addressed at TMH. PuBLICaTIoNS PRESENTaTIoNS CEN Review Manual. Building an organ donor Program: Fourth edition (2009). how to, What to and What do You Need? Terri Repasky, RN, MSN, CEN, EMT-P (contributor) National Association of Organ Procurement Organizations National Conference. Miami, Florida (August 2010) developing Processes to Enhance Multidisciplinary Care. Barbara Gill MacArthur, RN, MN, FAAN; Christy Corbitt, RN, CPTC Oncology Issues, Nov/Dec 2010. EBP in the Real World. Anne Hatcher, RN (contributor) 11th Annual EBP Conference 2010 Preconference Workshop, Glendale, Arizona (2010). Insulin Pump Therapy versus Injection for adolescents with diabetes. Robin Kretschman, RN, MSN, NEA-BC Diabetes Research and Clinical Practice, Volume 89, Issue 2, (August 2010). Implementation of an organ donation Collaborative Team Adela Mitchell, RN, CDE at Tallahassee Memorial hospital. Lifequest Organ Recovery Services Regional Conference. Pensacola, outcome Management Matters. Florida (2010) Nursing Management , 41(8): 13-16 (2010) Barbara Gill MacArthur, RN, MN, FAAN Robin Kretschman, RN, MSN, NEA-BC Pain Management in orthopedic Patients. Radiation Therapy Skin Guidelines: Management by Condition. Orthopedic Nurse Association Annual Conference (May 2009) Revised, 2010. Kathy Barnett, RN, MSN; Milt Dahl, RN, MS Anne Hatcher, RN (contributor) The Relationship between BodySize, Risk Perception of developing Type 2 diabetes and Likelihood of Lifestyle Behavior Change Sheehy’s Emergency Nursing Principles and Practice. among african american Women. Sixth Edition, (2010) National Association of African American Studies National Association Terri Repasky, RN, BSN, CEN, EMT-P (contributor) of Hispanic & Latino Studies National Association of Native American Studies International Association of Asian Studies (NAAAS & Affiliates) Conference. Baton Rouge, Louisiana (February 2010) Temperature Measurement in Pediatrics: a Comparison Brenda Owusu, RN, MSN, ANP-BC of the Rectal Method versus Temporal artery Method. Journal of Pediatric Nursing (Published on line, 2011) how We Make the System Work for You at the 2010 Southeast Cerner Jessica Bahorski, RN, MSN, PNP-BC; Terri Repasky, RN, MSN, CEN, EMT-P; Regional User Group Meeting in Tampa Florida, April, 2010 Donna Ranner, RN, CPN; Ally Fields, RN, BSN, CEN,; Michelle Jackson, BS, Allison Mars, RN BSN, and Francesca Holladay, RN, BSN CCLS: Lucy Moultry, RN; Karen Pierce RN-BC; Mary Sandell, RN, MAdEd. Creating a Culture of Falls Prevention Florida Organization of Nurse Executives Conference, 2009 Patty Esher, RN, MHA, BSN 24 2010 NURSING ANNUAL REPORT NEW KNOWLEDGE & INNOvATION Research and Evidence-Based Practice studies Nursing research fosters professional development and advances nursing science. We are proud to report that TMH had many research studies underway with nurses serving as principle investigators or co-investigators, including 47 active studies, 18 completed studies and 14 studies led by nurses, which are listed below. The TrialNet Natural history Study of the development of Type I hospital Elder Life Program (hELP) Version 3: May 30, 2008 diabetes, Protocol, TN-01, Version: Feb. 15, 2007 Kenneth V. Brummel-Smith, MD; Lisa Granville, MD; Nick Nelson, MD; Larry C. Deeb, MD; Adela Mitchell, RN, CDE Christopher Dunlap, MD; Kasinal Cashe White, RN, BSN, MSN; Kym Holcomb, BSW human Papillomavirus acceptability vaccine among a Rural Sample of Women over 16 Years a Comparison of the Effectiveness of a Standard Log Book versus the Laura Davis, RN Internet or voice Recognition System When Monitoring Pregnant Women with Gestational diabetes CREaTE II: Building Telehealth home Care Systems for older adults Larry Deeb, MD; Kim Rohrbacher, RN Neil Charness, PhD; Ryan Yordon; Dawn Smith, RD, CDE; Linda L. Fevrier, BSN, CDE; Ryan Best The Effect of Nursing on NICu (Neonatal Intensive Care unit) Patient outcomes Evidence-based Practice Implementation Scale Deborah Merritt, RNC, BSN Robin Kretschman, RN, MSN New Nurse Residency-an Evidence Based approach Evidence-based Practice Beliefs Scale Alice Nied, RN, MSN, NEA-BC Robin Kretschman, RN, MSN a Comparative Study of a Non-invasive Temperature device versus organizational Culture & Readiness for System-Wide Integration an Invasive Temperature device in Pediatric Patients in an Emergency of Evidenced-based Practice Survey Center and Inpatient Pediatric unit Robin Kretschman, RN, MSN Terri Repasky, RN, MSN, CEN; Michelle Jackson, BS, CCLS; Jessica Bahorski, ARNP-C; MSN; Ally Fields, RN, BSN; Lucy Moultry, RN; Karen Pierce, RNC; Donna Ranner, RNC; Mary Sandell, RN, MAdEd NICa Compliance Study Arthur Clements, MD; Erin Schleicher; Colleen Killian hIv-aIdS Coordination of Care Research Norman Pasley, RN, BSN 2010 NURSING ANNUAL REPORT 25 EmPIRICAL QUALITY RESULTS NursEs frOM THE CArdiOvAsCuLAr LAB are among those whose units scored high in nursing satisfaction. seated: rhonnie schaeffer, rN, BsN. standing (left to right) mean Change in Quality of Care Over Past Year sherry McBride, rN, BsN, Patty Brown, rN, BsN, Barbara 1 Hurlston, rN, and Mary Ann valentine rN. 0.8 RN Satisfaction Propels 0.6 0.4 Improvements in Quality of Care 0.2 n.d. Nursing satisfaction at TMH is measured using the National Database 0 for Nursing Quality Indicators (NDNQI) survey tools. This year, 784 -0.2 of our registered nursing colleagues who provide direct care for our -0.4 patients participated in the survey along with 136,000 peers from -0.6 hospitals across the country. The practice environment was evaluated by 90% of those eligible to participate, far exceeding the national -0.8 participation rate of 65%. This strong level of response provides -1 invaluable input as we strategically progress in nursing at TMH. 2006 2007 2008 2009 2010 -1 = Detoriated 0 = No change +1 = Improved Average of all units at TMH All comparison units in all comparison hospitals 26 2010 NURSING ANNUAL REPORT 4 Practice Environment Scale mean Scores EmPIRICAL QUALITY RESULTS 3.18 3.12 3.09 3.06 3.06 3.04 3.03 2.98 2.98 2.96 2.97 2.93 2.93 2.86 2.86 3 2.82 2.80 2.78 2 1 0 Nurse Nursing Nurse Manager Staﬃng and Collegial Mean PES Participation Foundations Ability, Leadership, Resource Nurse-Physician Score in Hospital for Quality and Support Adequacy Relations Aﬀairs of Care of Nurses Average of all units at TMH Average of all comparison units Average of all comparison units in all hospitals in teaching facilities The Results RN satisfaction at TMH out-performs the national average in every category. leadership and support of nurses; staffing and resource adequacy; and collegial This includes job enjoyment scores and the mean change in quality of care over nurse-physician relations. the past year. The NDNQI Survey is a valuable tool that benchmarks hospitals with like RN Satisfaction at TMH also out-performed the national average in every hospitals and each unit with like units across the country. The consistent category that contributes to the practice environment scale: nurse participation improvement in the practice environment that has been seen in each area in hospital affairs; nursing foundations for quality of care; Nurse Manager ability, reflects the improvements in quality of care that have been seen at TMH. 2010 NURSING ANNUAL REPORT 27 EmPIRICAL QUALITY RESULTS Tracking Empirical Results Helps Improve Quality at TmH TMH Nursing colleagues recognize that nationally benchmarked data can be used to help improve the quality of patient care we provide and the environment in which nursing is practiced. Nursing-sensitive indicators reflect the structure, process and outcomes of nursing care provided at the bedside. To provide a comparison, TMH is a member of the National Database of Nursing Quality Indicators® (NDNQI), a proprietary database of the American Nurses Association that collects and evaluates unit-specific nurse-sensitive data from over 1,700 hospitals. These unit-level comparative data reports are used for quality improvement projects. As a member of the NDNQI, Tallahassee Memorial also has the opportunity to participate in an annual RN survey, which alternates its focus from year to year between job satisfaction and the practice environment. (See article on previous page.) RN JOB PLANS JOB EmPLOYmENT SCALE T-SCORE PERCENT Of PATIENTS WITH HOSPITAL % Remaining on Same Unit for Next Year <40=low satisfaction 40-60=moderate satisfaction > 60= high ACQUIRED PRESSURE ULCERS 100% 70 10% GOOD 9% 90% 8% 60 7% 80% 6% 50 5% 70% 4% 3% 40 60% 2% 1% 50% 30 0% 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 2007 2008 2009 2010 2007 2008 2009 2010 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 TMH NATIONAL MEAN TMH NATIONAL MEAN TMH MED-SURG COMPARISON GROUP 28 2010 NURSING ANNUAL REPORT EmPIRICAL QUALITY RESULTS INJURY fALLS per CATHETER-ASSOCIATED UTIs fOR CENTRAL LINE-ASSOCIATED BLOOD- 1000 PATIENT DAYS ADULT & PEDIATRIC ICUs STREAm INfECTIONS for ADULT & PICUs 2.00 6.0 3.0 GOOD GOOD GOOD 1.75 5.0 2.5 1.50 4.0 2.0 1.25 1.00 3.0 1.5 0.75 2.0 1.0 0.50 1.0 0.5 0.25 0.00 0.0 0.0 1/14 2/14 3/14 4/14 5/14 6/14 7/14 8/14 9/14 10/14 11/14 12/14 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 TMH NDNQI MED-SURG MEAN TMH NHSN COMPARISON GROUP TMH NHSN COMPARISON GROUP CENTRAL LINE-ASSOCIATED BLOOD- vENTILATOR-ASSOCIATED PNEUmONIA vENTILATOR-ASSOCIATED PNEUmONIA STREAm INfECTIONS fOR NICU fOR ADULT & PEDIATRIC ICUs fOR NEONATAL ICU 16.0 14.0 GOOD 6.0 GOOD GOOD 14.0 12.0 12.0 5.0 10.0 10.0 4.0 8.0 8.0 3.0 6.0 6.0 2.0 4.0 4.0 2.0 1.0 2.0 0.0 0.0 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 0.0 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 TMH NHSN COMPARISON GROUP TMH NHSN COMPARISON GROUP TMH NHSN COMPARISON GROUP Note: NHSN Pooled Mean for birth-weight category<750g used as comparison. Note: NHSN Pooled Mean for birth-weight category<750g used as comparison. 2010 NURSING ANNUAL REPORT 29 The region’s first Certified Stroke Center and only state designated Brain & Spinal Cord Injury Center. An Accredited Chest Pain Center with Percutaneous Coronary Intervention. The Big Bend area’s only accredited community hospital cancer program, affiliated with the Moffitt Cancer Center. The only birth facility in the Big Bend equipped to care for high- risk moms and critically ill babies. A State Designated Level II Trauma Center. Offering a wide range of minimally invasive surgeries including da Vinci® robotic surgery and single-incision procedures. The region’s only Neurological, Pediatric and Level III Neonatal Intensive Care Units. First hospital in the country to be recognized by the American Psychological Association as a Psychologically Healthy Workplace. Winner of the National Research Corporation’s Consumer Choice www.TMH.org Award for the sixth year in a row.
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