2016 Annual NURSING REPORT
A Message From the Vice President of Patient Care Services Dear friends and colleagues,
“ When you are a nurse you know that every day you will touch a life or a life will touch yours.�
Cheryl W. Hayes
The most important aspect of our work as nurses is touching the lives our patients to help them heal and reach their goals. Seeing people at their weakest and providing them with hope and encouragement is what you do every day. This annual report reflects only a portion of your daily work and is a tribute to what you have accomplished during 2016.
Congratulations goes out to the Intensive Care Unit for achieving Beacon status. Our ICU is the only one locally that has received this prestigious award. It was through the hard work of nursing and the interprofessional team that they were able to meet the Beacon standards. In April of last year, Kenmore Mercy Hospital opened the brand new, well-equipped Ambulatory Surgery and Post Anesthesia Care Units. The new areas were well planned out with the input from nurses who had a direct input on their working area. Also, in April, our Magnet document was submitted to the American Nurses Credentialing Center. It was accepted in December with the notification that we would have a Magnet survey early in 2017.
In 2016, we had nursing staff who we recognized for their commitment to patient care, compassion and accomplishments in nursing. We received many notes from our patients about how the nursing team made such a positive difference in their healing.
We cannot forget the strides you have made in patient satisfaction with our scores increasing, again reflecting the compassionate care you provide. I hope you enjoy reading our 2016 story of nursing and viewing the pictures that reveal your passion and commitment to taking care of others. Thank you for your healing touch. May God bless all of you in your nursing journey. You are amazing! Sincerely,
Cheryl W. Hayes, MS, ANP, NEA-BC Vice President of Patient Care Services
Editorial Staff
Dawn M. Cwierley, AS, BS Cheryl W. Hayes, MS, ANP, NEA-BC Anne Hedges-Creighton, BSN, MS, RN Amber Mazurek, BSN, RN, ONC Kristen Parisi, BSN, CCRN, RN Heather Telford, MS, RN, CEN
Leadership Messages Pgs. 2 - 3
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Transformational Leadership Pgs. 4 - 7 ICU Beacon Award Surgical Services Expansion Research Conference Nursing Interns Isolation Carts Treating Opioid Overdose Operating Room Safety
Structural Empowerment Pgs. 8 - 13 Outstanding Nursing Awardees Community Outreach LOVE Awardees and Nominees DAISY Awardees and Nominees Fulfilling Community Needs Outstanding Associates Mammogram Screenings RN to BSN Program Therapy Dogs Magnet Essay Contest Winner Surgical Technologist Awardee
A Message From the President & CEO Dear dedicated nursing team members,
This 2016 Nursing Annual Report showcases many of the accomplishments that our nursing team has achieved in the last year. The individuals highlighted on these pages are only a few of the many who interact with our patients and their families every day. Their passion and compassion is evident through the care they deliver. James M. Millard
In May of 2014, Kenmore Mercy Hospital submitted its first application to the ANCC Magnet Recognition Program office, initiating our Journey to Magnet Excellence.
Having embarked on this multi-year Magnet Journey, it is clear that you have made the commitment to sustain the highest excellence in nursing practice.
Our document is the story of how you are transforming nursing care, practice, and learnings along the way. We are building on our rich history that traces its roots to early nurse leaders who were Sisters of Mercy, and eventually the lay leaders who followed in their footsteps. The energy and enthusiasm demonstrated throughout our Magnet Journey has been truly amazing. Your commitment to patient care and your pride in our facility is palpable.
At Kenmore Mercy Hospital, we are more than an organization, we are a “family,� that not only cares for our patients, but cares deeply about our community and for each other.
This journey has certainly reinforced the importance of everyone working together towards a common goal, and serves as a reminder of all that can be accomplished when we do so. Thank you to all of our nursing team today and throughout our history for the exceptional experiences you have created for our patients. Sincerely,
James M. Millard, R.Ph. President & Chief Executive Officer Exemplary Professional Practice Pgs. 14 - 17 CIWA Protocol 2016 Certifications CleanSlate TigerText Gum Chewing Study
New Knowledge, Innovations, & Improvements Pgs. 18 - 21 Narcotic Diversion Awareness Robotic Surgery Foundation Funded Education Leapfrog Ranking Awards Achieved
Empirical Outcomes Pgs. 22 - 23 Patient Experience Ratings Care Management C - Diff CLABSI Pressure Ulcers
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Transformational Leadership ICU Receives Beacon Award for Critical Care Excellence Congratulations to Kenmore Mercy’s Intensive Care Unit nurses for once again achieving the Beacon Award for Excellence - Silver Level in 2016. The award recognizes exceptional nursing and patient care in the critical care setting. Kenmore Mercy is currently the only hospital in the Buffalo area to achieve Beacon status.
The American Association of Critical-Care Nurses (AACN) Beacon Award designates three levels - bronze, silver and gold levels so that a unit can chart its excellence journey over time. Beacon Award recipients receive a three-year designation. For nurses, a Beacon Award signals a positive and supportive work environment with greater collaboration between colleagues and leaders, higher morale and lower turnover.
Cheryl Hayes speaks about the Beacon Award with Mary LaMartina, Karen Duerr, and Chris Dowd.
”As a bedside critical care nurse, I am very proud we have received the Beacon Silver Award. We are blessed with an outstanding interdisciplinary team within our unit. Each and every individual on our team is a champion of care, promoting the standards of excellence this award denotes,” said Mary LaMartina, BSN, RN CCRN.
Surgical Services Expansions Completed Kenmore Mercy completed the final stages of its multiyear surgical services expansion project this past year with the opening of a new Ambulatory Surgery Unit (ASU) in April and Post Anesthesia Care Unit (PACU) in July. In addition, this phased project included the building of two new state-of-the-art surgical suites, renovation of the Sterile Processing Department, updates to the Pre-Surgical Testing Unit, and purchase of the da Vinci Xi Robotic System. The hospital has invested nearly $13.3 million into transforming the Surgical Services Department. “The renovations were part of the hospital’s plan to enhance the patient experience, increase efficiencies, and improve access to surgical services,” said Anne Hedges-Creighton, BSN, MS, RN, director of Nursing, Perioperative Services.
Ambulatory Surgery Unit registered nurses Maureen Mycek, Dawn Kearney, Joanne Luciani, and Irene Stevens attended the opening of the new space.
The PACU and ASU staff were very involved in the planning of their new areas.
“They were integral in reviewing & revising operational processes, establishing patient flow, patient assignments and supplies,” noted Margy Donofrio, BSN, RN, CNML, CAPA, CPAN, nurse manager of Ambulatory Services, the Post Anesthesia Care Unit and Pre-Surgical Testing.
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Nursing Presents at Research Conference Kenmore Mercy’s nursing team presented five research posters at the 29th Annual Nursing Research & Scholarly Activities Conference in April 2016.
The night-long event, sponsored by the Professional Nurses Association of Western New York and the Nursing Honor Society “Sigma Theta Tau International” (Gamma Kappa, Gamma Theta and Zeta Nu chapters), brought together nursing colleagues from across the Buffalo area to share their contributions.
The five Kenmore Mercy research projects included: Patients on the Move: Increasing Hospital Ambulation by Utilizing a Mobility Program; Journey to Excellence – Achieving the Beacon Award Designation; Safe Patient Handling With A Nurse manager Ellen Swan (to the right), is seen here speaking with “Move with Care” Program; Improving Communica- conference attendee Marilyn Boehler, RN, regarding the “Move With Care” tion within the Surgical Services Department; and program. Redefining Triage: Implementation of a Two Tier Triage System. The “Move with Care” poster, presented by Ellen Swan, BSN, RN, CNML, and Kathleen Vitthuhn, MSN, RN, NEBC, received the Bronze Researcher Award and $20 gift card for their presentation. The posters were very well received with many requests for more information on the studies and how to start these projects in other settings.
Nursing Interns Reap Benefits of Experience Kenmore Mercy Hospital welcomed three nursing interns from the University of Buffalo and Niagara University during the summer of 2016 as part of Catholic Health’s paid program for Bachelor of Science in Nursing (BSN) candidates.
They worked on 3 East, 2 West and in the Operating Room full time for eight weeks. The program offered a unique opportunity for students to increase their clinical experience in a progressive, comprehensive healthcare setting under the preceptorship of an experienced registered professional nurse. The BSN students collaborated with an appointed nurse preceptor to mentor them in the field of professional nursing. They provided evidence-based care to patients and developed clinical experience in basic nursing procedures while observing and assisting their preceptor with advanced procedures.
The internship program provided students with the opportunity to utilize the nursing process in a clinical setting as well as develop communication skills and interpersonal relationships in a collegial environment.
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New Isolation Carts Aid in Reducing Infection Risks As part of Kenmore Mercy’s ongoing efforts to reduce the risk of infection transmission in hospitals between patients, healthcare workers and visitors, thirty new Stanley isolation carts with rubber wheels and quiet closing drawers were purchased in 2016.
The new isolation carts, which provide quick, organized access to personal protective gear and supplies, are placed outside the doors of patients with contact, droplet, or airborne precautions. “This ensures protection of both the associates and the visitors from the infected patients,” said Ellen Swan, BSN, RN, CNML, nurse manager of the 2 West Patient Unit. In addition, the use of isolation carts protects noninfected patients in the hospital.
Pictured here are Kayla Limardi, BSN, RN, Kayla Hoffman, BSN, RN, Another consideration when purchasing the new and Brooke Little, BSN, RN, with the isolation carts that they helped isolation carts was the reduction of noise on patient to design and pilot. floors. “Many of the carts in service previously were old and metal; they were very loud when they were rolled down the hall,” added Ellen.
The purchase of new isolation carts, which was made possible by the Kenmore Mercy Foundation, ended up being a great associate and patient satisfier.
ED Nurses Training Serves Opioid Overdose Patients Over the past two years, the opioid and heroin drug crisis has claimed more than 300 lives in Erie County. These are trying times for emergency personnel who are frequently dealing with opioid overdoses.
Following suit with the rest of Erie County, Emergency Department nurses at Kenmore Mercy Hospital completed training in 2016 on how to recognize a possible opioid drug overdose and administer the lifesaving drug naloxone (trade name Narcan).
Emergency Department nurse manager Amanda Kramer, BSN, CEN, RN, and senior clinical advisor Susan McClure, BSN, RN, completed training with the Erie County Department Health in the spring of 2016. They, in turn, trained additional ER nurses to meet the needs of the community.
In a partnership with the Erie County opiate task force, Kenmore Mercy continues to improve access to Narcan in the community. Patients and families in need of this assistance are trained by Emergency Department nurses in the recognition of overdose symptoms and the immediate, life-saving actions to follow. Nasal Narcan administration kits are then provided at discharge.
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Nurses Enhancing Safety in the Operating Room Perioperative clinical nurses and surgical technologists took concerns regarding the perceived amount of associate injuries related to lifting surgical supply trays (SST) into their own hands in 2015. This resulted in their workgroup creating both an innovative and cost effective solution.
According to the Association of periOperative Registered Nurses (AORN), musculoskeletal injury ranks among the highest for perioperative clinical nurses. It was noted by the nurses that a large portion of the surgical supply trays were in excess of the AORN recommended 25 pounds, which played a role in the musculoskeletal injury rates among the perioperative clinical nurses. The perioperative Unit Base Council clinical nurses met with the surgical technologists, Sterile Processing Department (SPD) representatives, perioperative nurse clinical advisor Burgundy Mullen-Dedde, BSN, RN, CNOR, Anne Hedges-Creighton, BSN, MS, RN, director of Perioperative Nursing, and the nurse safety officer Jason Meder, RN, to initiate the process of evaluating the surgical supply trays.
The workgroup evaluated each surgical supply tray and identified which ones weighed 25 pounds or greater. They ultimately decided on a detailed labeling strategy. The unwrapped trays proved to have a simple solution. They were marked on all four sides “≥25lbs”. For wrapped trays, it was decided that weights would be differentiated by their wrapping color - blue for those under 25 pounds and pink for over 25 pounds. Since the current paper used to wrap surgical trays is blue to the outside and pink to the inside, this solution was cost effective as well.
For outside vendor trays, the workgroup instituted a “vendor drop off” log in which the weight of each tray was documented upon arrival. The workgroup educated the vendors as they came on site to the new process of the safety initiative. This ensured all SSTs would be weighed and properly labeled to enhance employee safety and keep the new practice consistent. Placement of the trays in the Operating Room (OR) was also presented as a concern by the nurses. The decision was made that all trays identified as weighing 25 pounds or greater would be placed in the center of the case carts to allow for the set up to be ergonomically correct. This is easily monitored by the visual identification in both SPD and in the OR by having the pink wrapped SSTs in the center.
Ray Washington, sterile processing technician, shows the new wrapping protocol.
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Structural Empowerment Nursing Staff Awarded for Outstanding Commitment
Irene Stevens, BSN, RN Jean Wood, BSN, RN Benjamin Kanaley, NA Ambulatory Surgery Unit Emergency Department 2 East/2 South Held annually from May 6 - 12, Nurses Week, focuses attention on the diverse ways that nursing works to save lives and to improve the health of millions of individuals. Kenmore Mercy Hospital capped off National Nurses Week by recognizing some of its best nursing staff during a special ceremony held on May 11, 2016. 2016 Nurse of Distinction Jean Wood, BSN, RN, Emergency Department, began her nursing journey 27 years ago as a nursing attendant while going to school to become a licensed practical nurse. She then completed a Bachelor’s degree in Nursing Education from Niagara University. 2016 Outstanding Staff Nurse Irene Stevens, BSN, RN, was a nurse at Kenmore Mercy Hospital for 45 years, having worked in the Surgical Unit, staff development, Intensive Care Unit, Pulmonary Rehabilitation, and in the Ambulatory Surgery Unit. She is a graduate of D’Youville College. 2016 Outstanding Nursing Attendant Benjamin Kanaley, 2 East/2 South, has been with Kenmore Mercy Hospital since 2011. Benjamin completed a Master’s degree from Canisius College in Health and Human Performance, as well as a Bachelor of Arts in History and Social Studies Education from Buffalo State. Congratulations to all of our nursing honorees and thank you for your dedicated service to our patients.
Registered nurses Sister Mary Walter and Patti LaRusso enjoyed the 2016 Nursing Luncheon.
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Operating Room nurses Jessica Paduano and Jenna Juliano took time out of their day to enjoy the annual Nursing Luncheon.
Nurses Active in Community Outreach Achieving the health and well-being of patients at Kenmore Mercy reaches beyond the walls of hospital rooms. Nurses have recognized this need and reached out to the community through a variety of educational events and healthcare screenings. In February, which is Heart Month, the nurses on 3 East and in Cardiology Services teamed up to host a Go Red for Women Awareness Day and National Heart Day. They sold red dress pins and encouraged staff to show their support of the cause by wearing red. In addition, they organized heart healthy informational displays with the Pharmacy, Dietary, Rehabilitation and Nursing Departments. They also provided blood pressure screenings. In recognition of Colon Cancer Awareness Month and Gastrointestinal (GI) Nurses & Associates Week in March, the GI nursing team hosted an education fair and speakers to help individuals gain a better understanding of colorectal cancer and gastrointestinal diseases.
During Pulmonary Rehabilitation Week in March, nurses hosted an informational table to educate individuals about chronic obstructive pulmonary disease, asthma, chronic bronchitis, or pulmonary fibrosis. They also provided screenings. As part of PeriOperative Nurses Week in November, nurses in Preoperative Testing, Orthopedics, and Surgery created a poster and showcased hardware for knee and hip replacements in the hospital’s atrium. This included key Knee & Hip Center statistics. In addition, they shared actual equipment used in surgeries, including prosthetics used in joint surgery.
The multidisciplinary group that makes up the Palliative Care Committee also hosted an advanced directive day in August to answer questions about Health Care Proxy and/or MOLST forms and advance directive planning. Thank you to these dedicated nurses for their commitment to improve the health of others with their proactive actions and service.
Registered nurses Lisa Finn and Karen Hamp provided screenings to visitors and associates, including patient access specialist Tracy Gamble Bonner.
Registered nurses Betty LoFaso, Burgundy Mullen-Dedde and Kim DeGlopper presented at the Perioperative table.
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LOVE Awards: Nursing Staff Living Our Values Effectively Catholic Health’s LOVE Award is designed to recognize employees who demonstrate our values of reverence, compassion, justice, and excellence - in their daily work. Many members of Kenmore Mercy’s Nursing team are nominated for the LOVE Award every year.
2016 LOVE Awardee
Nursing Team Nominations:
Santana Adams, NA – 3 East Mary Yap-Bloniarz, RN – 2 West Melissa Caldwell, RN – 3 East Denise Chatt, NA – MRU Lynn DeGrasse, RN – 2 East Michelle Giallella, NA – 3 East Mary Harper, NA – 2 East Francine St. John, RN – Case Manager Danette Lee, Unit Clerk – 2 East Michelle Marella, RN – ICU Mary O’Heir, NA – 3 East Thomas Roe, RN – 2 East Bridget Walborn, RN - ICU Denise Walker, NA – 2 West Gita Zhulovchinova, RN – 3 East
Donnell Manuel, NA 2 East/2 South Fourth Quarter 2016
DAISY Awards: Nurses Recognized for Compassion 2016 DAISY Awardees
The DAISY Award was established by the DAISY Foundation in memory of J. Patrick Barnes who died at the age of 33 of idiopathic thrombocytopenia, an autoimmune disease. The Barnes family was awestruck by the clinical skills, caring and compassion of the nurses who cared for Patrick and created this national award to say thank you to nurses everywhere. DAISY stands for Diseases Attacking the Immune SYstem. Nurses are nominated by our patient families and our DAISY Award winners are selected twice a year by the hospital’s Nursing Shared Governance Committee based on their compassionate bedside manner and excellent clinical skills. Kenmore Mercy has recognized the DAISY Award winners since 2014.
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Bobby Gross, RN 3 East Spring 2016
Jessica Klug, BSN, RN Intensive Care Unit Winter 2016
DAISY Award Nominations in 2016: 2 South Nursing Staff Maureen Audino Judy Arnold Jennifer Barone Dan Diddas Chris Dowd Jason Kiszka Sarah Luckett Lydia Moreno Karyn O’Keefe
Tina Ouellette Ilyana Rahman Jennifer Rennells Ellen Rusch Caroline Sweeney Denise Walker Gina Willett Julie Wolcott Elizabeth Woods
Nursing Helping to Fulfill Community Needs Kenmore Mercy’s nursing team addresses the needs of the community through their work every day. In doing so, they are living Catholic Health’s values of reverence, compassion, excellence, and justice. In 2016, they showed these values in a number of ways that go above and beyond.
Throughout the year a number of associates volunteered at Catholic Health’s charity of choice, Friends of Night People, serving in the community kitchen and distributing non-perishable goods to clients.
At Christmastime, associates from various disciplines joined forces to bring some joy to the elderly clients of Ken-Ton Meals on Wheels. This idea was generated from the Shared Nursing Governance Committee. They collected 115 holiday care packages of socks, slippers, blankets, This multidisciplinary team helped collect and candy and greeting cards. This was in addition to their annual Thanksgiving basket donations to benefit families in the Ken-Ton area.
deliver items for senior citizens in the Ken-Ton community.
Several of our nurses also completed medical mission trips in 2016, demonstrating Catholic Health’s values globally.
Julie Baumgartner, RN
From February 20-27, operating room registered nurse Janice Vosburgh traveled to Santo Domingo in the Dominican Republic as part of her nonprofit World Spine Outreach. Working in conjunction with Butterfly Foundation, 22 spinal corrective procedures were performed on children and young adults, changing their lives forever. Janice was joined by Kenmore Mercy’s David Vogt, MD, anesthesiologist, and Jennifer McCarthy, operating room resource assistant.
In October, 2016, Gena Long, RN, from 2 East/2 South, and Julie Baumgartner, RN, from the Emergency Department, traveled to Chulucanas, Peru, with the Global Health Ministry. Gena and Julie both served on the surgical team where they worked as an OR circulating nurse and a post anesthesia care nurse.
Gena Long, RN (center)
The Global Health Ministry served the poorest population in the rural mountains at their health care compound where Gena and Julie stayed during their two week trip. Cases included severe burns, cleft palates and lips, physical deformities, hernias, pterygiums and cataracts, uterus prolapses, diseased gallbladders and more.
Thank you to all of our nursing staff for their dedication to caring for others at home and abroad.
Outstanding Associates Recognized by Medical Staff Physicians at Kenmore Mercy recognized Elizabeth Allard, unit clerk in the Emergency Department, and Deborah McCoy, RN, from the 2 East Patient Care Unit, with the Annual Medical Staff Associate of the Year Award for 2016. Dr. Michael Gough presented Elizabeth Allard with her award.
Deborah McCoy is pictured here with her manager ,Mary Hojnacki.
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Ken-Ton FamilyCare Program Increases Mammograms Ken-Ton FamilyCare is working to provide women, many of whom probably would not have otherwise done so, receive breast cancer screenings. On Fridays, five times a year, a bright pink “Mobile Mammography Coach” can be found parked outside the primary care office located at 300 Two Mile Creek. The goal is to reach out to underserved and under-tested women in the northtowns.
Breast cancer screening through annual mammography and breast physical examinations is highly successful in diagnosing early onset of the disease and improving survival rates among women.
However, among minority and low income groups, there are barriers to participation in these screening activities. These barriers include economic challenges, problems with transportation, access-related factors, inconvenience and lack of time, lack of physician recommendation, psychological factors such as fear and fatalism, lack of knowledge and awareness of breast cancer risk, and misunderstanding of recommended screening frequency.
While women who fell into the recommended age range for mammograms had previously been given a prescription, the compliance rate was low. With the addition of the “Mobile Mammography Coach,” the screening became accessible to these women. Since the initiation of the “mammogram bus” in December 2014, Ken-Ton FamilyCare has seen a sustained increase in the percentage of women getting their annual mammograms performed.
Four Nurses Complete “RN to BSN” Program Kenmore Mercy Hospital continues to work with Niagara University to build its future leaders through the “RN to BSN” degree program for registered nurses who want to advance their careers. The program is a series of credit courses held primarily at Catholic Health over 30 months and results in a Bachelor of Science in Nursing.
In May 2016, four of our nurses graduated from the program. Congratulations to Elizabeth Kaminski, RN, Kristine Dix, RN, Mary Jane Lodico, RN, and Holly Grimm, RN (shown to the right).
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Therapy Dog Gets Some TLC From Nurses When Kenmore Mercy’s beloved therapy dog Sydney tore her ACL this past May, it was she who needed some TLC.
While the little Yorkshire Terrier who visits patients every week needed bed rest, she and her handler Gail Fechter were still dedicated to visiting patients. The hospital’s orthopedic nurses came to her rescue with a small baby stroller to help her get around. Sydney is one of several therapy dogs who visit Kenmore Mercy. The specially trained dogs and their handlers visit hospital units regularly, providing patients with much appreciated petting time. After the visit, patients are smiling, feel a little less tired, and a bit more optimistic. Family members and friends who sit in on pet therapy visits say they feel better, too. Of course, the dogs also appreciate all the extra love. Sydney had a cast while she recovered from her ACL surgery.
Essay Contest Winner Shares Thoughts on Magnet In August, the Magnet team gave clinical nurses the opportunity to write an essay for a chance to win a trip to the 2016 Magnet Conference that was held in Orlando, Fla. Each essay that was turned in had to meet certain criteria which included: • Describe how implementing the nursing professional practice model and pursuing Magnet status drives the quality of nursing care at Kenmore Mercy Hospital. • What would achieving Magnet status mean for your nursing practice? • How can Kenmore Mercy effectively promote the Magnet vision among the nursing staff?
Registered nurse Alan Chittley, ONC, from 2 East/2 South, was the winner of the Magnet Essay Contest. Not only did Alan create the concept of our current Nursing Professional Practice Model, but he was also able to capture the essence of its connection to nursing care at Kenmore Mercy.
Alan wrote, “Our practice model shows how our strong base of nursing care, rooted in a long history of excellence, can be used to build that which will provide the best outcomes for our patients and families. We are professionals. We must act, do, and carry ourselves as professionals. No matter where we are located in the ladder of patient care we must always do what is right, respectful, fair, and compassionate. We must be practitioners that stand out in the nursing community.”
Surgical Technologist Awarded for Outstanding Work
Congratulations to Judy Fratini (seen to the right). She was winner of the 2016 Outstanding Surgical Technologist Award. Surgical Technologist Week was celebrated September 18 - 24.
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Exemplary Professional Practice CIWA Improves Care of Patients at Risk for Alcohol Withdrawal In an effort to improve the care of hospitalized patients at risk for and experiencing alcohol withdrawal symptoms, an interdisciplinary workgroup at Kenmore Mercy Hospital developed a Clinical Institute Withdrawal Assessment for Alcohol (CIWA) protocol for the assessment and treatment of alcohol withdrawal symptoms (AWS).
Each patient admitted to the hospital is screened for risk of developing AWS at the time of admission using a brief four question screening tool administered by the nurse. If a patient is found to be at risk for alcohol withdrawal, the nurse contacts the admitting provider to advise that the patient is at risk, and to inquire about whether a CIWA protocol should be ordered. If the provider deems a CIWA protocol to be appropriate, an order set is initiated. The CIWA-AR is a validated assessment tool for assessing the presence and severity of alcohol withdrawal symptoms. Once the protocol is ordered, a CIWA-AR assessment of alcohol withdrawal symptoms is completed and the CIWA-AR is calculated by the nurse.
The CIWA-AR score is used to determine whether benzodiazepine therapy should be administered for treatment of alcohol withdrawal symptoms. Benzodiazepine dosing is stratified based on CIWA-AR score, so that more severe alcohol withdrawal symptoms (higher CIWA-AR scores) will be treated with larger benzodiazepine doses. The CIWA protocol also dictates the timing of subsequent CIWA-AR assessment. If on serial CIWA-AR assessments, the patient is found to have no symptoms of alcohol withdrawal, the protocol stops. Using protocolized benzodiazepine dosing based on CIWA-AR assessments for alcohol withdrawal symptoms is a validated, evidence-based practice. Use of CIWA-AR based care protocols have been demonstrated to improve outcomes in patients with alcohol withdrawal symptoms, including reducing the overall severity of AWS symptoms, and preventing progression to full blown delirium tremens or alcohol withdrawal seizures.
The efficacy of the protocol lies in ensuring AWS symptoms are recognized early in their course and treated with benzodiazepines to mitigate their severity, and prevent progression. The screening tool improves the staff’s ability to identify patients who may be at risk for AWS, and the CIWA protocol provides the interdisciplinary care team with a tool to ensure at-risk patients are carefully assessed in a structured and reliable fashion. AWS can be recognized as they begin to emerge and promptly intervened upon with appropriately dosed benzodiazepines. CIWA protocols have been used successfully at other hospitals and medical centers. Members of the medical staff and nursing staff had experience using them and identified CIWA protocol based care for alcohol withdrawal potentially for patients. They assembled an interdisciplinary team, developed a protocol for the facility, and have piloted the protocol at Kenmore Mercy since early 2016.
In implementing the pilot, the nursing staff was extensively educated on the screening questionnaire, CIWA-AR assessments, and use of the CIWA protocol. Providers unfamiliar with CIWA protocol were provided with education around its use. Several providers were identified as CIWA champions and familiarized with the protocol so they may be available to help with any issues or questions regarding use of the protocol. The protocol was first piloted in the ICU at Kenmore Mercy and was subsequently made available for use in ED, and inpatient medical and surgical nursing units where it has been successfully used to care for multiple patients.
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2016 Certifications Adult Nurse Practitioner (ANP) Cheryl W. Hayes, NP Connie Skulski, ANP Esther Sprehe, ANP
Certified Emergency Nurse (CEN) Amanda Kramer, RN Heather Telford, RN
Board Certified Nurse Practitioners (CNP) Rita Colicchia, NP Susan DePlate, NP Mary Dowd, NP Elizabeth Grundtisch, NP Andrea Schmitt, NP Esther Sprehe, NP Sister Mary Walter, NP Certification in Cardiac Medicine (CMC) Sandra Conti, RN
Certified Gastroenterology Nurse (CGRN) Heidi Frushone, RN Janet Gonzalez, RN Jane Weidner, RN
Certification for Nurse Managers and Leaders (CNML) Margy Donofrio, RN Christine Schwinn, RN Ellen Swan, RN Certified Nurse Operating Room (CNOR) Rachel Achtziger, RN Linda Butski, RN Cara Howitt, RN Burgundy Mullen-Dedde, RN Melissa Kowalski, RN Esther Sprehe, ANP Jacob Walck, RN Certified Post Anesthesia Nurse (CPAN) Scott Berube, RN Margy Donofrio, RN Pam Farrell, RN Sue Hartl, RN Rene Marriott, RN
Certification in Wound Ostomy Nursing (CWON) Mary Applegate, RN Certification in Diabetic Education (CDE) Irene Haefner, RN Critical Care Registered Nurse (CCRN) Julie Bajor, RN Melissa Borgese, RN Sandra Conti, RN Christopher Dowd, RN Kristyn Durick, RN Rachael Kaplan, RN Brenda Cramer, RN Mary LaMartina, RN Lori Ann Meder, RN Tom Nader, RN Kristen Parisi, RN Maria Richardson, RN Connie Skulski, RN Bridget Walborn, RN Elizabeth Wood, RN Lisa Smith, RN
Interventional Radiology Nurse Certification (CRN) Deborah Arnet, RN Kathleen Daley, RN Christine McGee, RN Robert Morello, RN Med-Surg Certification (CMSRN) Johanna Boyd, RN Nancy Chojecki, RN Brenda Cramer, RN Annette Gillies, RN Jessica Klug, RN Carole Woomer, RN Jessica Yormick, RN
Nurse Executive, Advanced-Board Certified (NEA-BC) Cheryl W. Hayes, NP Nurse Executive, Board Certified (NE-BC) Kathleen Vitthuhn, RN Elaine Schrutt, RN Orthopedic Nursing Certification (ONC) Delreta Billips, RN Alan Chittley, RN Christine Clark, RN Sydney Dirk, RN Nicole Faulkner, RN Briana Geddis, RN Mary Hojnacki, RN Pamela Koetzle, RN Betty LoFaso, RN Amber Mazurek, RN Deborah Micholas, RN Christine Reaser, RN Susan Wasielewski, RN Suzanne Zeisz, RN Certified Ambulatory Nurse (CAPA) Margy Donofrio, RN Certified Case Manager (CCM) Jodie Cwiklinski, RN Nina DiCarlo, RN Deb Hurd, RN Ella Mendez, RN Sandy Olear, RN
Certified Registered Nurse First Assistant (CRNFA) Esther Sprehe, ANP This list includes certifications completed prior to December 2016.
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Hospital Helps 43North Winner Test New Device Washing our hands with soap and water or hand sanitizer is one of the most effective ways to kill germs and prevent the spread of colds, flu and other infections. But, what about our cellphones? Because we touch our phones every day, they can be a breeding ground for all sorts of germs and bacteria. In our continuing efforts to prevent the spread of any infections, Kenmore Mercy Hospital has teamed up with a Buffalo-based healthcare startup – CleanSlate UV – to trial a new device that uses ultraviolet light to safely disinfect smartphones, tablets and other mobile devices. Kenmore Mercy Hospital was one of just four hospitals in the country using the CleanSlate UV device in a trial run in 2016.
The UV technology is designed to kill germs without harming devices not suitable for normal cleaning techniques such as soap and water or disinfectant wipes. The CleanSlate UV unit, which is about the size of a toaster oven, sits at a nursing station or near the entrance of a nursing unit allowing staff and visitors to clean their mobile devices in-between patients or before visiting loved ones. The unit’s ultraviolet light emitting technology can sanitize mobile devices in about 30 seconds. Kenmore Mercy trialed the system in its Surgery Department and Intensive Care Unit.
“Like all Catholic Health hospitals, Kenmore Mercy places a high emphasis on standard infection control protocols, including proper hand washing, wearing protective gloves, using the most effective disinfectants, and the careful use of antibiotics,” said Lisa McCabe, Catholic Health director of Infection Control. “We are, however, always looking for new technology to enhance our infection prevention efforts.”
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Dr. Timothy Rasmussen demonstrates simplicity of the disinfection process.
Texting Application Improves Collaboration & Communication Like many hospitals throughout the United States, Kenmore Mercy found itself faced with the ever growing challenge of safe and HIPPA-compliant communications.
In October of 2016, the hospital piloted TigerText, an internet based clinical communications application. “The goal is to improve communications and reduce errors, by connecting medical providers and the care team through real-time messaging,” noted Edward A. Stehlik, MD, MACP, chairman of Medicine for Catholic Health. Kenmore Mercy Hospital has been an early adapter of the application, with majority of its patient care units now using TigerText to reach out to providers about patient tests, sharing necessary images, and planning discharges. “This is the way of the future,” added Dr. Stehlik. “Look at how our younger generation communicates with one another already.”
Andrea Schmitt, NP, is a frequent user of TigerText. Using this type of instant and secure communication also allows multiple parties to be connected at once and reduces overhead paging, thus improving patient safety and patient experience.
Furthermore, the application allows nurses and providers to enhance medical communications, while completing tasks from anywhere on the floor, which in turn lets them spend more time with their patients.
Gum Chewing Study Impacts Post-operative Hip Patients
Post-operative ileus (POI) is a well-known complication and concern of many gastrointestinal and non-abdominal surgeries. In 2016, 2 East/2 South registered nurse Sydney Dirk performed a research study on 2 South to examine the impact of gum chewing on ileus rates in post-operative hip replacement patients. POI places the patient at an increased risk for complications and may lead to discomfort, delayed recovery, longer hospital stay, patient dissatisfaction, and a lower Healthgrades rating. Post-operative ileus affected ten percent of orthopedic surgeries in 2014.
Because gum chewing is a form of sham feeding, which has been reported to enhance bowel motility, Sydney introduced chewing gum with sorbitol into the patients’ post-operative regime. POI, as well, as partial obstructions may be prevented and maintenance of normal bowel function may occur. The patients’ who agreed to participate in the research as part of the experimental group, were given chewing gum, containing sorbitol, to chew for 30 minutes after each meal. Sydney’s findings were as follows: • Control Group (no chewing gum provided) had a POI rate of 1.87% • Experimental Group (chewing gum provided) had a POI rate of 0% Due to the proven effectiveness of gum chewing to reduce post-operative ileus in elective joint replacement patients, the practice was adopted on 2 South for all post-operative total hip and total knee replacement patients. POI rates will continue to be monitored.
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New Knowledge, Innovations & Improvements Nursing Helps Increase Awareness of Narcotic Diversion Narcotic use and diversion in healthcare is a growing problem across the United States that may be difficult to identify.
After listening to concerns from the nursing staff, Kenmore Mercy leadership decided to raise awareness about the situation by hosting a special multidisciplinary session in August. The event featured speakers from the Office of Professional Discipline, the Bureau of Narcotic Enforcement and the Attorney General’s Office. Staff members from all departments were welcome to join the informative and interactive presentation.
Registered nurses Emily Rotolo and Sandy Conti, BSN, CCRN, CMC, from the ICU, “There are several indicators that can help demonstrate proper waste disposal. managers and front line nurses to recognize signs of illicit drug use in the workplace,” noted Intensive Care Unit nurse manager Kristen Parisi, BSN, RN, CCRN, one of the event’s organizers.
“This event was designed to help everyone become more knowledgeable about those signs and to intervene at an early stage if needed,” she added.
Job performance, narcotic use monthly statistics, and personality/mental status are some of the indicators used to identify diversion. Workplace access can contribute to the availability of the narcotics, increasing the level of concern for diversion. Certain methods of diversion may be hard to detect. Methodical and persistent monitoring is necessary to ensure the safety of both the patients and the associates from the harmful effects of diversion.
Kristen noted that there were several excellent take away points from the presentation. For instance, when a person signs as a witness to waste narcotics, it is mandatory that the waste is done when the medication is pulled, and that it is observed until completion.
Having a narcotic in your pocket for “later use” or “in case it is needed” for a patient is considered illegal possession of a controlled substance. Report any suspicious activity to your manager. It may be unwarranted and explainable – but you just may save someone’s life.
“This program provided our nursing team, as well as other disciplines, with the needed education to be prepared to identify incidences of inappropriate narcotic use and diversion before they cause harm to the individual or anyone else,” Kristen added.
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Nurses Play Role In Enhancing Robotic Surgery SAM, short for Surgical Associate Machine, the robot officially joined Kenmore Mercy Hospital’s minimally invasive robotic surgery team in 2016.
In February, the hospital’s surgeons started using this latest generation of da Vinci Xi Robotic Surgical technology, which is setting the standard in minimally invasive surgical care. Hospital associates had the chance to experience their own hands-on tutorial with the robot during an event called “A Date with da Vinci” on February 4 and 5.
While it is referred to as a “robot,” the da Vinci system cannot act on its own. In fact, it’s more like an extension of the surgeons’ hands, as they sit comfortably behind a computerized console. The console features a monitor that provides a magnified, high-definition 3D image of the surgical site, along with hand controls that direct the machine’s robotic arms, which guide the laparoscopic instruments.
Colleen Pawlowski, surgical technologist, Derek Miller (Intuitive Surgical), Grace Logi, RN, Donna Florio, RN, Dr. Richard Buckley, Esther Sprehe NP, and Ellen Colan, RN, senior clinical advisor, celebrated completion of 100 procedures.
Appropriately named after Leonardo da Vinci, the surgical system captures the famed artist and inventor’s technological ingenuity and inventive imagination. Surgical robots like the da Vinci offer many advantages for surgeons, including unparalleled precision due to better visualization of the surgical field, correction for tremors in hand movements and greater maneuverability of instruments. Minimally invasive robotic surgery brings important benefits for patients, such as less blood loss, reduced risk of blood transfusion and a shorter overall recovery time. For perioperative nurses, the addition of surgical robotic systems creates new learning opportunities to stay abreast of technology in a constantly changing landscape of new techniques, and improved instruments and equipment.
As of December 2016, Kenmore Mercy’s surgical team completed more than 100 procedures using the da Vinci Xi Robotic Surgical System. Tonawanda Middle School sixth-grader Jonathan Dickson (to the left) named the winning entry for the new da Vinci Surgical System Contest. SAM is an acronym for Surgical Associate Machine. Jonathan received a behind-the-scenes, “test drive” of SAM and a $50 Target gift card. Nearly 200 students aged 5 to 11 from Northtowns school districts submitted entries for the contest. Kenny, Stitch and Surge, or variations of those, were among the most frequently suggested names.
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Foundation Funding Provides Education to Nursing Staff A special thank you to the Kenmore Mercy Foundation who raises funds to provide key financial support for staff education. In 2016, the Foundation funded more than $18,265 in courses for nursing associates, including those listed below.
Basing Your Practice on The Evidence (4 nurses) Good Work and Mentoring in Nursing Program (17 nurses) 2016 American Nurses Credentialing Center National Magnet Conference (2 nurses) AORN Conference (2 nurses) Association of PeriOperative Registered Nurses Conference (2 nurses) Association of Medical Rehab Nurse Online Program Critical Care Conference Critical Care Education (2 nurses) Difficult Airway Course (physician assistants) Emergency Neurological Life Support Course Gastrointestinal Certification (3 nurses) Improving Wound Care 2016 (20 nurses) One way that the Foundation raises funds is the annual Tribute To Angels Event. Amber Mazurek, BSN, ONC, RN, and Deborah Micholas, Joint Commission Resources Conference BSN, ONC, RN, were among the attendees at the 2016 event. Kettering Review for Registry Exam National Qigong Association Conference North American Spine Society Conference (2 nurses) WNY Annual Regional Symposium (3 nurses) Nursing Management Congress 2016 Conference WNY Nursing Symposium (6 nurses) NYSAT 2016 Spring Conference WNY Society of Gastroenterology Nurses and Orthopedic Educational Seminar (2 nurses) Associates Fall Conference (3 nurses) Shoulder and Elbow 2016 Update Conference Stroke Education - ENLS Course (3 nurses) Stroke Treatment Alliance Symposium Vestibular Rehabilitation: Interdisciplinary Symposium (2 nurses)
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Kenmore Mercy Scores High In Leapfrog Ranking Kenmore Mercy is one of 115 hospitals across the country, and the only hospital in New York State, to be named a “Top Hospital” by The Leapfrog Group. Being acknowledged as a “Top Hospital” is an incredible accomplishment achieved by less than three percent of hospitals nationwide. The coveted award recognizes hospitals across the country for excellence in quality of care and patient safety. “This recognition is a testament to the hard work and commitment of everyone associated with Kenmore Mercy Hospital - our interdisciplinary team, nurses, staff, our physicians and our volunteers,” said Cheryl Hayes, MS, ANP, NEA-BC, vice president of Patient Care Services.
Of the “Top Hospitals” recognized across the country, nine were recognized as Top Children’s Hospitals, 56 were named Top General Hospitals, 21 were named Top Rural Hospitals, and 29 were named Top Teaching Hospitals. Kenmore Mercy was included in the Top General Hospital category.
Also of special note, Kenmore Mercy Hospital received its sixth consecutive “A” rating from Leapfrog in its Fall 2016 Hospital Safety Score update, a program that grades more than 2,500 U.S. hospitals. Kenmore Mercy Hospital was the only local hospital to receive an “A” in both the spring and fall 2016 cycles.
The selection of “Top Hospitals” is based on the results of the 2016 Leapfrog Hospital Survey. Performance across many areas of hospital care is considered, including infection rates, physician staffing within the Intensive Care Unit, and a hospital’s ability to prevent medication errors. You can view the selection criteria and the full list of institutions honored as 2016 Top Hospitals, by visiting www.leapfroggroup.org/tophospitals.
Hospital Recognized for Excellence Kenmore Mercy’s nurses are leaders in the profession, earning national awards.
• The Ken-Ton FamilyCare Center, was recognized by the National Committee on Quality Assurance (NCQA) for its success in creating a centralized “medical home” for patient care. The Patient-Centered Medical Home (PCMH), the highest level recognition from NCQA, is a model of care that emphasizes a strong clinician-patient relationship in which a clinical team coordinates all aspects of patients’ health needs in order to achieve more personalized and effective delivery. • Kenmore Mercy Hospital received the 2016 Get With The Guidelines® (GWTG) Gold Plus Quality Achievement Award for Stroke and Heart Failure care from the American Heart Association/American Stroke Association. These awards recognize Kenmore Mercy’s commitment to ensuring that the hospital delivers the most appropriate care to stroke and heart failure patients based on nationally recognized, research-based guidelines.
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Empirical Outcomes Nursing Helps Improve Patient Experience Ratings Kenmore Mercy continues to lead the way in Catholic Health with increased Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores each year. For the year-end we exceeded our target goal of 73.9 percent, by achieving 76 percent. This continued increase in patient experience ratings confirms that associates’ efforts to reduce noise, round on patients, and answer call bells timely is working. Initiatives used to specifically help reduce noise included adding Yacker Trackers on patient care units to measure sound levels, closing kitchen doors at 8:30 p.m., reinforcing hourly rounding to reduce call bell noise, reviewing medication administration times, addressing loudness, using the Restful Night
menu, assigning “Quiet Champions” for all shifts, and purchasing new isolation carts. Thank you to all of our nursing associates for their work to achieve these impressive results! Kenmore Mercy Hospital
Patient Experience Overall Rating
100%
90% 80% 70%
76.0%
72.7%
73.7%
2015
2014
60% 50% 2016
Overall Rating Positive Response
2016 Target = 73.85%
Care Managers Improving Patient Care Transitions
Discharging patients from the hospital is a complex process with many challenges. Kenmore Mercy’s Care Management team has been instrumental in redesigning processes to improve care transitions and decreasing the average length of stay. More recently, Care Management assumed a more active role in interdisciplinary rounds with a focus on discharge planning.
The team members in these rounds include the charge nurse, Pharmacy, Spiritual Care, Social Work, and Care Management. Each discipline works together to broaden their understanding of each other’s role which will ultimately improve patient experience.
The team has been integral in identifying discharge delays. The most consistent issues identified include: the lack of a physical therapy order by physicians, (especially for individuals in observation), patients refusing to participate in therapy when needed for discharge plans, family delays choosing a rehabilitation facility, completing a financial application, family delays deciding on comfort care, and end of life issues.
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Case management registered nurses like Sandy Olear, Michelle Ginter, Fran St John, Sue Ederer, Ella Mendez,and Deb Hurd are making a difference in patient care.
Some process improvements include a new census report with insurance and diagnosis, a separate daily observation report that identifies observation patients and hours in observation, and a network screener initiative to facilitate discharges to rehabilitation. Thank you to our Care Management nurses and social workers who are helping to improve patient safety, enhance the patient experience and reduce the cost of care.
CLABSI
C-Diff
Sustained reduction of central line-associated bloodControl of Clostridium difficile infection (C-Diff) stream infections (CLABSIs) remains elusive in many outbreaks in hospitals presents significant challenges institutions. Kenmore Mercy has successfully sustained to healthcare workers. Kenmore Mercy continues to efforts in recent years to reduce CLABSIs and in 2016 make strides to reduce infections, thanks to continued had zero. interprofessional collaboration. Nursing identifies patients flagged with central lines daily in Soarian. This allows providers to better adKey tactics have included: dress the need for the line. • meticulous hand hygiene with soap and water after There were also focused efforts on device utilization leaving the room, every time; of central lines/patients days) reduction. • placing patients in contact precautions when C-Diff (number If less central lines are present in patients, there is a test is ordered and keeping them there until the test lower chance of infection. returns negative; • placing orange contact precaution sign outside CLABSI rooms to remind associates to use soap and water 0.8 only, not alcohol based hand sanitizer; 0.7 0.75 • always keeping patients suspected of having C-Diff 0.6 in contact precaution for the duration of their admis0.5 sion even after their diarrhea has resolved; 0.50 0.4 • using the TempDot disposable thermometer when 0.3 obtaining rectal temperatures; 0.2 • using the five Cs when assessing whether a patient 0.1 can leave their room when they are in contact pre0.00 0.0 caution; 2016 2015 2014 Is my patient Competent, Continent, Clean, Contained and Cooperative? CLABSI RATE per 1,000 2016 Target = 0.25 • cleaning non–critical, reusable medical equipment with bleach between patients; and • cleaning high touch areas with bleach, every day, in every patient room. In 2015, the hospital set out to aggressively reduce the percentage of pressure ulcer incidents. It successfully C-Diff saw a significant reduction in 2015 and has continued 7 to keep numbers low.
Pressure Ulcers
6 5
5.69
5.56
2016
2015
5.90
4 3 2 1 0
C-DIFF Rate per 10,000
Tactics included standardization of pressure ulcer specific interventions, working with interdisciplinary teams and leadership, addressing accountability, designating skin champions and providing education.
Pressure Ulcers
2014 2016 Target = 4.36
180% 160% 140% 120% 100% 80% 60% 40% 20% 0%
1.61
0.76 0.57
2016
2015
2014
Hospital Acquired Pressure Ulcers
2016 Target = 0.57
Hospital Acquired Pressure Ulcers
2016 Target = 0.57
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OUR MISSION
We are called to reveal the healing love of Jesus to those in need.
OUR VISION
Inspired by faith and committed to excellence, we will lead the transformation of health care in our communities.
OUR VALUES
Reverence - Nursing reflects our values and mission by the acknowledgement of the sacredness of human life and the individuality of their needs and goals.
Compassion - Nursing provides compassionate care by identifying the connectiveness of each person through the relationship with each other and their environment.
Justice - Nursing advocates for our patients to achieve their personal goals, respecting and recognizing the differences in each individual.
Excellence - Nursing continually strives for quality and excellence through the care we deliver through communication to our patients, families and the interdisciplinary team.
Nursing strives to interact with our patients to achieve their goals, promote, maintain and sustain health and to ensure satisfaction of the care the patient receives.
Est.
1951