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NURSING
BAYHEALTH PATIENT CARE SERVICES 2019 ANNUAL REPORT
BAYHEALTH.ORG
LEADERSHIP & PLANNING
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TRANSFORMATIONAL LEADERSHIP
8-11 STRUCTURAL EMPOWERMENT
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NEW KNOWLEDGE INNOVATIONS & INFORMATION
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EXEMPLARY PROFESSIONAL PRACTICE
14-17 EMPIRICAL OUTCOMES
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BAYHEALTH NEWS & RECOGNITIONS
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NOTEWORTHY
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TRANSFORMATIONAL LEADERSHIP
We embrace Planetree philosophies and believe in treating the whole patient – mind, body and spirit. • Our core values are compassion, accountability, respect, integrity, and teamwork. • Our work as nurses is grounded in research and evidence-based practice.
I N NUR S I NG & HE ALT H STRUCTURAL EMPOWERMENT
EMPIRICAL OUTCOMES
• Our goal is to achieve nursing excellence. • Our goal is achieved through advocacy, empowerment and collaboration.
NURSING EXCELLENCE
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Patient Care Services Annual Report 2019
ASED PRACT ICE!
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EXEMPLARY PROFESSIONAL PRACTICE
NEW KNOWLEDGE, INNOVATION & IMPROVEMENTS
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LEADERSHIP & PLANNING
At Bayhealth, our model of care is patient- and family-centered.
I SS AL
A Message from the Chief Nurse Executive (CNE) The year 2019 started with a bang and then ended with excitement. We started the year with the opening of the new Sussex Campus. The campus opened bright and early on Tuesday, Feb. 5. We had a beautiful day with perfect weather and a flawless move. All patients were in their new rooms ahead of schedule. The teamwork was amazing along with the plan that went like clockwork. The year ended knowing our Magnet document was in the hands of our Magnet survey team and a site visit to follow in the spring of 2020. Other noteworthy events that occurred throughout the year include: Shared governance is a very important process at Bayhealth. In 2019, the councils voted to evaluate the Shared Governance Model. After the evaluation, the teams voted to change the model to decrease the number of councils and they even created a new Shared Governance Structure. The new structure clarifies the role of nursing within Bayhealth showing the patient in the middle surrounded by the councils and Bayhealth values.
Pictured on the cover is 2019 Nurses of the Year, Clinical Coordinator Caricia Rickards (right) for Bayhealth Sussex Campus and Registered Nurse Idalis Stamas (left) for Bayhealth Kent Campus.
The Clinical Nurse Specialist (CNS) group decided they could make a bigger difference within the organization if their structure was changed. Several of our CNSs now have privileges within Bayhealth which allows them to be more independent as they care for our patients. Each CNS was also given focus areas and they created their own goals for the fiscal year. They each have scorecards to track their progress as they help move the organization in the right direction for outstanding patient outcomes. Many of the Bayhealth nurses were recognized throughout 2019 for their achievements. Several staff were recognized within the organization for their outstanding performance through our DAISY award program. Others were recognized at a state and national level. Bayhealth has plenty of reasons to be proud. I hope you enjoy reading about 2019 and how you have made a difference in our organization, community, and the world of nursing.
Brenda Blain, DNP, RN-BC, FACHE, NEA-BC Chief Nurse Executive/Senior Vice President
Bayhealth.org/Nursing
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Patient Care Services 2018-2020 Strategic Plan Long before 2019 officially began, we were busy working through each of our strategic goals to ensure that progress was made on achieving them. Our mission is to strengthen the health of the community one life at a time, and each of these goals will aid us in living this mission. Our strategic goals correlate with Bayhealth’s strategic plan – organizational excellence, culture, access & growth, and clinical integration. Here are some of the ways we’re making progress on our strategic goals:
Progress Report ORGANIZATIONAL EXCELLENCE • Reduced 30-day readmissions. • HRO training is ongoing & a requirement for all new hires. • Magnet Redesignation application document accepted with expected site visit in early 2020. • The majority of unit level nursing quality indicators met or exceeded benchmarks in 2019 when compared to Magnet peer group.
ACCESS & GROWTH • Opened Bayhealth Sussex Campus with smooth and successful transition of patients from Milford Memorial. • Collaborations with Nemours established to expand local access of pediatric care. • New Mmaternal triage and peri-natal testing unit serve higher-risk pregnant patients and their babies. • Emergency Department patients that left without being seen dropped by 1% this year. • Hospital orientation program revamped.
CULTURE • Shared Governance restructured for improved efficiency. • 51% of eligible RNs have earned specialty certification. • Nurse satisfaction met or exceeded Magnet peer group benchmarks, demonstrated by the NDNQI RN survey. • Emerging Leaders developmental days and Driven to Lead course series opened enrollment for clinical coordinators to enhance succession planning. • Caring for our Caregivers: CISM introduced, Code Lavender, Pet Therapy for employees, NAPPI deescalation training for improved safety.
• Bedside nurses initiate Clinical Nurse Specialist (CNS) consults. • Nurse navigator positions added to improve continuity and quality of care for our patients and community.
CLINICAL INTEGRATION • Developed plans to continue to expand outpatient services. • A transition to practice program for new or transitioning registered nurses developed. We are preparing for PTAP (Practice Transition Accreditation Program) certification in 2020. • Peer Recovery Specialists & strengthened Mental Health services added to ED teams.
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Patient Care Services Annual Report 2019
2018 – 2020 Goals • Increase inpatient overall patient satisfaction to meet or exceed annual organizational targets
ORGANIZATIONAL EXCELLENCE
• Increase emergency department overall satisfaction to meet or exceed annual organizational targets • Reduce hospital acquired infections to meet or exceed annual organizational targets • Reduce 30 day readmissions to meet or exceed annual organizational targets • Actively participate in and support the process to become a High Reliability Organization • Assure that 100% of staff attend High Reliability baseline education by July 2018 • Implement Safety Tool Kit by July 2018 • Apply for Magnet redesignation in 2019 • Continually assess unit-level nursing quality indicator data to ensure that Magnet peer group benchmarks are met or exceeded
CULTURE
• Increase percent of direct care nurses with BSN or higher by 1% annually: 2017 Baseline = 54%, 2018 Goal = 55%, 2019 Goal = 56%, 2020 Goal = 57% • Increase percent of direct care nurses with national specialty certification by 1% annually: 2017 Baseline = 47%, 2018 Goal = 48%, 2019 Goal = 49%, 2020 Goal = 50% • Increase retention of direct care nurses by 2% over 2017 baseline by Dec. 2018 (2017 Baseline = 84.1%, 2018 Goal = 86.1%) • Assure RN Satisfaction meets or exceeds Magnet peer group benchmarks • Formalize succession planning programs for nursing leadership roles (CNS, Nurse Manager, Nurse Director) • Support Planetree initiatives that promote patient and family centeredness • Achieve silver designation by July 2018
ACCESS & GROWTH
• Transition the Milford Campus to the new Sussex Campus; with patient move in Feb. 2019 • Address care transitions across the continuum of care: • Implement quality improvement ratings for post acute facilities by Fall 2018 • Hire / develop role of a Post Acute Manager by Spring 2018 • Apply new strategies to address maternal health • Formulate a peri-natal testing and obstetrical emergency services plan at the Kent Campus by Jan. 2019 • Implement an OB Hospitalist program at Kent Campus in 2019
CLINICAL INTEGRATION
• Implement Palliative Care program at Milford Campus by Jan. 2018, expand services to outpatients by 2020 • Implement transition to practice program for RNs new to Bayhealth and apply for program certification (PTAP) by 2019 • Standardize operational and clinical nursing practices to promote efficiency and support a high reliability culture (Standard Work) • Complete gap analysis for Sussex Campus by Jan. 2018 • Build action plans for Sussex Campus; complete applicable workflows by Sept. 2018
Bayhealth.org/Nursing
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TRANSFORMATIONAL LEADERSHIP
TERRY M. MURPHY, FACHE PRESIDENT AND CHIEF EXECUTIVE OFFICER
CHERI BRIGGS, BS PHARM D., MBA SENIOR DIRECTOR OF PHARMACY SERVICES
FAITH COLWELL-DORIO, MSN, RN, NEA-BC, VHA-CM SENIOR DIRECTOR OF PERI-OPERATIVE SERVICES
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BRENDA BLAIN, DNP, RN-BC, FACHE, NEA-BC SENIOR VICE PRESIDENT FOR PATIENT CARE SERVICES/CHIEF NURSE EXECUTIVE
ANGELINE DEWEY, MSN, RN, APRN, ACNS-BC, CCRN,CNRN DIRECTOR OF EDUCATION
GUST BAGES, MHA, BSN, RN SENIOR DIRECTOR OF EMERGENCY AND TRAUMA SERVICES
SHARON URBAN, MSN, RN-BC, CNML, NE-BC SENIOR DIRECTOR OF PATIENT CARE SERVICES – KENT AND SUSSEX CAMPUSES
MARIANNE FOARD, MS, RN, NE-BC, PRC DIRECTOR OF SERVICE EXCELLENCE/PATIENT ADVOCACY & PROFESSIONAL RECRUITMENT
CHERYL HEWLETT, PHD, MBA, MSN, RN, NEA-BC
CHRISTIE TOMASESKI, MSN, RN-BC
SENIOR DIRECTOR OF WOMEN’S & CHILDREN’S SERVICES
MAGNET PROGRAM MANAGER
Patient Care Services Annual Report 2019
Safety Huddles Daily safety huddles primarily led by the Chief Nurse Executive (CNE), Dr. Brenda Blain has resulted in great strategic organizational change. The safety huddles include an interdisciplinary team of staff nurses, nursing leadership, ancillary departments, and physician colleagues. Each team member in attendance is prepared to discuss nurse sensitive indicators such as falls, hospital acquired skin issues, central lines, foley catheter use, and readmission data. The team collaborates on ideas to reduce the incidence of these items as part of Bayhealth strategic goals. Outstanding equipment and environment issues, as well as, safety lessons learned and “good catches� are shared
with the team for complete transparency of information across the organization. Enhanced communication between departments and improved patient outcomes such as a lower number of hospital acquired conditions have been consistently demonstrated since the institution of the daily safety huddle.
Bayhealth team members are taking a new approach when it comes to healthcare-acquired infections (HAIs). HAIs are identified through surveillance activities and subsequently discussed at daily safety huddles. Once an HAI occurs, a multidisciplinary team assembles for a bedside huddle, referred to as a SWARM, to discuss the case. This interdisciplinary team includes Infection Prevention, Pharmacy, Food and Nutrition, Environmental Services, unit staff, unit leaders, clinical nurse specialists, and other members of the Medical Staff. Bayhealth.org/Nursing
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Centralized Float Pools With patient safety at the forefront of what we do, Bayhealth is making changes across the board to ensure we’re doing everything we can to make patient care safe. One such change is the merging of the nursing float pools to one centralized float pool team.
MycKenzie Gillette loves being in the float pool, and is looking forward to the opportunity to work at the Bayhealth Hospital, Sussex Campus now that the float pool has merged. Float pool nurses are full-time nurses who work a regular three-day schedule, but instead of being assigned to a particular unit, these nurses work based on the needs of the hospitals. When Bayhealth had two separate float pool teams, there were times where one hospital had a disparity of nurses while the other had a wealth of nurses. “Combining the float pool will help us ensure, to the best of our ability, that all nursing units have the coverage they need,” said Angie Lord, nurse manager for house supervisors and the float pool. Float pool nurses are now oriented to work at both hospitals. Each float pool nurse has been trained for acuity adaptable, meaning they can care for both med-surg and intermediate care (IMC) patients. All nursing units at Bayhealth Hospital, Sussex Campus are acuity adaptable. Two units at Bayhealth Hospital, Kent Campus – 4A and 3 West – are acuity adaptable. Having acuity adaptable units helps Bayhealth keep med-surg and IMC patients on the same unit rather than transferring a patient when they’re upgraded or downgraded. Float nurses will also be given the opportunity to specialize in a particular area of interest. MycKenzie Gillette and Juan Vergel joined the float pool as new nurses, and love having the opportunity to work on a different unit each day. “I worked in the float pool 10
Patient Care Services Annual Report 2019
as a CNA and going back as a nurse is the best decision I could’ve made. It’s a great way to work in different areas before committing to a specialty,” Gillette said. Working in different units has allowed Vergel to meet and learn from a lot of nurses. “Each nurse is like a little encyclopedia. Someone on 3 West knows something that someone on 2 North wouldn’t necessarily know. I want to learn as much as I can from each of them,” said Vergel, who is grateful for his preceptors and all of the managers he’s worked with thus far. Christine Taylor had already been a nurse for five years before making the move to the float pool. Leaving a unit she loved was hard, but doing so brought with it an opportunity to grow and learn as a nurse. “At Bayhealth, we’re one unified team so it makes sense to have a centralized float pool,” Taylor said. “I’m excited to be able to work on acuity adaptable units and to work at the new hospital. Not many nurses get to have the experience of working at a new hospital and being a part of its history.” Because of the nature of the float pool, Lord understands nurses may leave once they’ve found a specialty to work in so she’s driven to help her nurses achieve those goals. “I want to give these nurses the tools they need to move forward with their career while meeting the needs of Bayhealth at the same time,” Lord said.
Juan Vergel plans to spend his whole career working in the float pool because he enjoys it so much.
New Bayhealth team members are pictured here doing the new learning map at general orientation.
Human Resources Launches Revamped Orientation This fall, Human Resources launched a revamped general orientation. Through the new process, employees will only be in general orientation for one day and will receive much of what was previously introduced through an e-learning module. Making this change puts new staff with their department one day sooner. The new one-day orientation features a learning map that helps new hires learn what the Bayhealth way is all about. The focus of this one-day orientation will be on the culture of Bayhealth. “Our goal during orientation is to give employees an impression of what their career at Bayhealth is going to be. We want them to learn about the employee and patient experience,” said Organizational Development Director Lauren Brittingham. Onboarding sets the tone for the rest of a person’s time at their job, said Organizational Development Specialist Brittany Kern. What is discussed during the first day of a job is what new hires will believe is the most important part of their job. Many of the previous orientation sessions centered around mandatory education and are now included in an e-learning module. The module
includes education that is required upon hire by The Joint Commission and OSHA. This module gives new hires a more hands-on approach to learning the information, as well as something to refer to as needed. “Mandatory education is important, but that’s not what general orientation should be about. What’s more significant to talk about is our mission, vision and values. Staff need to know what’s essential to Bayhealth as an organization,” Brittingham said. “It’s vital to set the tone for who we are, what we do, why it matters, and the role new hires will play.” Along with learning about the Bayhealth culture, other orientation topics will include keeping yourself safe, benefits, payroll, and more. While some pieces of orientation are featured in the e-learning module, other pieces of required education and information were incorporated into the departmental orientations. If you assist with the onboarding of new hires in your department, talk with your manager for additional information. Bayhealth.org/Nursing
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STRUCTURAL EMPOWERMENT
Nursing Launches New Shared Governance Structure Shared governance is a participatory nursing model used at Bayhealth that empowers frontline nurses to have a voice in decision-making for the betterment of nursing practices and patient care. Work in recent years had created 15 Magnet councils and sub-councils, but a re-assessment of the existing structure and nursing feedback showed there was room for improvement. In October 2019, Magnet Program Manager Christie Tomaseski, MSN, RN-BC, and Clinical Educator Karen Merson, MSN, RN, NE-BC, began to assist with the transition to a revised shared governance model to improve communication between the unit-level councils and system-level councils, avoid silos and duplicative work, and streamline channels to create positive change. The new model was initiated with input at the nursing staff level, voted on, approved, and rolled out in less than three months, explained Merson. “We respected the past work everybody did and consolidated down to seven multi-disciplinary team councils,” she said. One major change is participation now begins at the unit base and communication is more open. The new governing body is the Patient Care Congress, comprised of representatives from every unit along with chairpersons of the system-level councils. Each unit council is also linked with a liaison from each system-level council to ensure system initiatives also exist at the unit level as well as to facilitate expanded, bi-directional communication. This provides a system whereby unit-level issues can be brought up by any nurse and effectively addressed. A primary project goal was to ensure an inclusive process and structure with broad nursing representation. Shared Governance Carnival events were held at Kent and Sussex Campuses in January to introduce the new model to the Bayhealth community. Tomaseski said this allowed staff nurses to better understand how their passion for particular areas could be plugged in to a new council, and it encouraged them to apply. Among applicants, finding a balance between different types of nurses, day and night shifts, campus location, and inpatient and 12
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ambulatory sites was an important objective. “We also invited some non-nursing key personnel to be part of the new councils because they offer unique points of view and areas of expertise that can impact nursing,” said Tomaseski. Supply Chain, Pharmacy and Performance Improvement are a few departments represented. The new councils have begun meeting and have chosen their leaders. An upcoming retreat will offer education and support for those less familiar with shared governance aspects, and there’s a standard bylaw template that can be easily modified for each unit. “We’re starting fresh and have such diversity on the councils now—a mix of RNs, BSNs and MSNs, nurses with tenure along with newer nurses with less experience on councils—so we can get different perspectives,” said Merson. “We strived to make everything staffdriven. We really need the bedside nurses to be leading this charge, so we’re giving them all the tools to be successful as leaders on their councils. Everybody has a voice at the table.” If you or your unit has questions about the new shared governance structure and would like further information, please contact the Professional Development Council through Angel Dewey at Angeline.Dewey@Bayhealth.org or 302-744-7188, or Christie Tomaseski at Christina_Tomaseski@Bayhealth. org or 302-744-6358.
Changing the Role of Clinical Nurse Specialists Clinical nurse specialists (CNSs) are master’s prepared, advanced practice registered nurses (APRNs) who specialize in specific areas of nursing practice. The CNS functions in a variety of roles, including providing direct patient care; consulting with nurses and physicians; educating staff and families; and leading evidence-based practice projects. Traditionally, this group of nurses has worked in a unit-based role at Bayhealth. This changed in late 2018 when the CNSs went from the unit-based model to a population health/service line model. Now the CNSs are experts that nursing units and providers across Bayhealth can turn to for help with
Acute Care • Michele Sturgeon – early recognition of deterioration and transition from intensive care and CLABSI prevention
Behavioral Health • Amanda Fisher – program management
Cardiac • Ludy Santiago-Rotchford – congestive heart failure and arrhythmia management • Dennise Washington – AMI, CABG, cardiovascular surgery
Geriatrics • Felicia Cruz – acute care of the elderly
certain populations of patients. For example, Robin Maracle was previously the CNS for the 1A Med/ Surg unit and Patient Transport. Now she’s focusing on decreasing readmissions in the COPD population and preventing hospital acquired infections, including pneumonia. This change also means that CNSs will be working across all of Bayhealth. “This gives us an opportunity to be a liaison between the different inpatient and outpatient departments. We’re no longer siloed to a particular unit,” said Cardiac Clinical Nurse Specialist Ludy Santiago-Rotchford, MSN, APRN, ACNS-BC, PCCN.
Neurosciences • Genna Helfrich – neurosurgery • Kimberly Holmes – stroke guidelines, neurology
Palliative Care • Robin Maracle – COPD, pneumonia and C-Diff • Jessica Taylor – palliative care
Pediatrics & Neonates • Sarah Knavel – children’s health and patient flow
Women’s Services • Jennifer Orlosky-Novack – Women’s Services, Labor & Delivery, OB emergencies, neonatal resuscitation, evidence-based practice
Bayhealth.org/Nursing
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EXEMPLARY PROFESSIONAL PRACTICE
Exemplary Professional Practice Nursing leadership at Bayhealth is driven to support the growth of our nurses. From encouraging team members to continue their education to helping them with certifications and providing professional development, we believe in cultivating the talent of our nurses and helping them grow to become nurse leaders in their own right. Doing so has brought much success to the nursing staff at Bayhealth, as shown through the below clinical nurse statistics.
737 FULL-TIME NURSES
51% CERTIFIED NURSES
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185
PART-TIME, RELIEF, OR PER DIEM NURSES
922
TOTAL NURSES
54.6% BACHELOR’S DEGREE IN NURSING
19.2%
RN TURNOVER RATE
11.2%
MASTERS DEGREE OR HIGHER IN NURSING
Team Effort Benefits Special Patient Population The project of creating sensory rooms at Bayhealth is an impressive demonstration of our organizational values and goals. The Emergency and Trauma Centers at both campuses and Bayhealth Emergency Center, Smyrna now have space and resources in place to better accommodate and care for patients with autism spectrum disorder (ASD) or other developmental disabilities. The concept was first suggested by ED Nurse Derek Sheets, RN, who has a passion for working with and on behalf of individuals with special needs. The Patient Experience Champion Team and ED partnered up a year ago to turn the idea into reality at Bayhealth. An action plan was created to provide the resources and staff education to reduce the obstacles faced by this special patient population and their caregivers in the ED. Sensory rooms are still rare in healthcare, however, data was collected and an internal steering committee of subject matter experts and a community partnership council, comprised of parents of individuals on the autism spectrum, was formed to give input and guide the process. Each Bayhealth ED designated a room and added sensory-friendly items— dim lighting, a calming LED light projector and staff care cards, instructing them on the ACT (Assess, Communicate and Treat) approach for ASD patients. They have carts with weighted vests; noise cancelling headphones; a tablet with special
communication applications; a robotic seal; and social stories, which are booklets developed by Christine McGuire-Chloros of Quality and Patient Experience and Speech Pathologist Arielle Allentoff to explain common procedures using imagery and simple language. The Epic team implemented an automatic notification staff can put in the system to identify patients with sensory issues, along with notes, to aid in future care. “A crowded ED can cause sensory overload for these patients, making it difficult to function,” said Sheets. “To avoid families leaving without being taken care of or having to drive further for treatment, we can help by offering this room.” ED Senior Nurse Manager Brad Crabtree, MSN, RN, CEN, said they’ve successfully used the room with the full process in place, and about half of their staff has been trained. “There’s a classroom overview of ASD to assist them in working with these patients and families,” said Crabtree. “This project is helping achieve better outcomes and is directly related to the patient experience, which is a priority for us.” Visit the ED page on BayNet to learn more about these sensory-friendly resources.
Bayhealth.org/Nursing
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Implementation of NAPPI Training Shows Decrease in Employee Injury Bayhealth’s Workplace Violence Program launched in 2018 with a goal of teaching team members, including nurses, how to deescalate situations before patients become violent. Through the program, staff members complete the NAPPI (Non-Abusive Psychological and Physical Intervention) training, which is designed to be non-abusive and effective for protection of self and others. “We’ve done a lot of research and Bayhealth is one of very few organizations that has a workplace violence manager and it’s really a big deal for us,” said Workplace Safety Program Manager Melissa Jones, BC-HSP. “We’re ahead of the curve!” The goals of the program are to improve the overall safety of all staff and patients and reduce the percentage of employees with work-related lost time injuries. Jones has led the NAPPI initiative and continues to educate staff on
NAPPI principles in both the classroom setting and with constructive feedback during debriefings following code greys. Code grey events alert specially trained personnel that immediate assistance is needed to deescalate a situation and help prevent harm or injury in the event that a patient, visitor or employee becomes violent. “The percentage of employees with work-related lost time injuries has decreased after implementation of the
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NAPPI program. Staff feels more comfortable assessing situations without having to use a code grey or Public Safety,” said Jones. Jones has been pivotal in the implementation of the violence indicators in Epic, the electronic chart system, and in establishing safety plans for patients with a known history of violence. In addition to the emergency department violence indicator, which helps to identify patients with violent behavior on the ED tracker, Jones and the Workplace Violence Taskforce team collaborated with clinical informatics nurses and
information technology specialists to implement a “High Risk Behavior FYI Flag” within the electronic medical record for patients. “This program really was built and approved by the executive leadership to ensure the clinical staff voices were heard. We want to make sure that they are safe. I’m excited about continuing to grow the program,” said Jones.
Periop Services Makes Award-Winning Changes In summer 2018, the Perioperative Services team began evaluating Operating Room (OR) processes. Their overall goal was to increase staff, surgeon and patient satisfaction at both hospitals. They also wanted to establish more shared governance among physicians, staff and other departments. In October 2018, they brought in consulting firm, Surgical Directions, to help them refine the process and continue to make improvements, including at the newly acquired surgery center on the Kent Campus. Over the next several months, they evaluated and revamped everything from scheduling to preadmission testing (PAT) and authorizations to the patient experience on the day of surgery.
as part of the project, cites improved communication between the departments and physicians’ offices and getting them all on board with shared governance as primary positive outcomes. “I believe we got the award because we continued to supply data to the Surgical Directions team that demonstrates our ongoing improvements not only for staff but for our patients.” There’s been an established goal to have a 92 percent or higher first case on time starts and turnover time of 27 minutes between cases. Striving for this has reduced overtime at the end of the day and allowed for patients to be better scheduled.
The interdisciplinary team’s hard work and dedication led to Bayhealth being named Surgical Directions’ Client of the Year for 2019. It also unified the surgical team and standardized processes at both campuses.
“The reason why you want your first case starts to be so high is because when you start your day with cases that aren’t getting into the room by 7:30 a.m. it backs up everything else for the day. The patients that are coming subsequently after that first case could be late,” expressed Colwell-Dorio.
Senior Director of Perioperative Services Faith ColwellDorio, MSN, RN, IA, VHA-CM, NEA-BC, who was hired
She credits the success of the perioperative team members to everyone understanding their roles and expectations.
Bayhealth.org/Nursing
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NEW KNOWLEDGE, INNOVATIONS & IMPROVEMENTS
Opening of Sussex Campus Following years of planning, building and preparation, the Bayhealth Hospital, Sussex Campus opened to patients on Feb. 5, 2019. The Bayhealth Outpatient Center, Sussex Campus quickly followed on Feb. 6, 2019. In addition to opening the new campus, leaders at Bayhealth also had to plan for the patient move from Bayhealth Milford Memorial to the new location. These plans were carefully coordinated by hundreds of employees who all took part in the planning and implementation. Bayhealth first announced plans to build the new health campus in late 2014. At the announcement, Bayhealth’s President and CEO Terry Murphy, FACHE, explained that “healthcare is changing, and at the same time so are the needs of our community. After evaluating the direction of healthcare and
conducting detailed research, we realized the community needs more than a hospital.” The new location was selected because of its visibility, access to Route 1 and space to grow. The project involved careful coordination on many levels that involved staff and provider input throughout the process. The community was also consulted. More than 300 community members took part in the “cardboard city” tours. These tours allowed community members to walk through cardboard mock-ups of key areas that would be built in the hospital. The community continued to support Bayhealth during the open house events once the hospital was built. More than 8,000 people toured the new facility.
Clinical Input Shapes Interior Design The Bayhealth Hospital, Sussex Campus has three private 24-bed Acute Care Units and is in the process of adding a fourth unit to the fifth floor to expand capacity by another 24-beds. Whether patients need an intermediate level of care or medical-surgical level of care, they receive it on an acuity-adaptable unit. “Our community partners, frontline staff, and providers played an important role in planning for the new Bayhealth Hospital, Sussex Campus,” said Vice President of Operations and Sussex Campus Administrator Michael Ashton, FACHE. “We appreciated their feedback and involvement in the project.” Nearly 150 people, including Bayhealth employees, clinical staff, volunteers, patients, and community members, tested and voted on their favorite furniture samples for the new hospital and outpatient center during a Furniture Demo 18
Patient Care Services Annual Report 2019
Fair. Participants sampled recliners, gliders, and sleeper sofas, and waiting room, exam room, and office chairs. They also observed how the furniture would fit inside of a patient room. The rooms also include many amenities that will further boost nurse safety along with patient comfort and safety such as same-sided rooms, safety rails, patient lifts, and nurse server storage units.
Transforming Care with Acuity-Adaptable Units Nursing units at both Bayhealth Kent and Sussex campuses have transformed to become acuity-adaptable in an effort to better care for patients. This means whether a patient requires med-surg or intermediate (IMC) levels of care, they will receive it on an acuity-adaptable unit. Research shows acuity-adaptable units reduce patient transfers, increase collaboration with unit staff and families, decrease the risk of patient falls, reduce infection rates, enhance continuity of care, improve communication with hand-off reports, and increase productivity. The Sussex Campus has three 24-bed Acute Care Units and the Kent Campus has two units that have transitioned from Med-Surg to acuity-adaptable in 2018. “One of the biggest benefits we’ve seen is the reduction in transfers within the hospital. By reducing the number of times a patient is transferred during their hospital stay, we are providing a safer environment,” said 4A Nurse Manager Verna Sellers, MSN, RN, CNML. “Other benefits are less fragmented relationships between patient and caregivers, leading
to improved relationships; a reduction in disruptions to patients; a reduction of lost patient belongings; a time savings for care-givers and EVS workers; and improved through put of patients.” With this different approach to care there is a belief that keeping patients in the same unit during their stay will lead to better outcomes, and improved patient management, patient satisfaction, and nurse satisfaction.
Lung and Colorectal Nurse Navigator Position Added The Bayhealth Cancer Institute added a nurse navigator specific to lung and colorectal cancers in 2018. This new position was created in partnership with the state of Delaware and in response to evidence showing these two patient populations would benefit from a dedicated resource focused on improving screening rates and educating our local communities.
Bayhealth Colorectal and General Surgeon Assar Rather, MD, said, “In addition to facilitating access to timely screening, diagnosis, and treatment, and increasing community awareness and outreach, as a nurse navigator, Trina will support the processes and protocols for multidisciplinary rectal cancer care. She will also handle data collection and monitoring to track care processes, treatment, and compliance with national guidelines.”
According to incidence and mortality rates in Delaware, there is much work to be done with lung cancer and colorectal cancer. “Increasing awareness, early detection, and screening rates, and decreasing late stage incidence will provide a tremendous opportunity for those in our community to change the way they think about and view their health,” said Bayhealth Cancer Institute Manager Stephanie McClellan, MSN, RN, CMSRN. “We are excited to have Trina Turner, MSN, RN-BC, LNC, join our staff as a dedicated lung and colorectal nurse navigator working Pictured left to right: Bayhealth General Surgery, Dover Nurse Practitioner with our patients, the community, Adrianne Fisher, MSN, FNP-BC; Bayhealth Colorectal and General Surgeon Assar and our physician partners to educate Rather, MD; Bayhealth Lung and Colorectal Nurse Navigator Trina Turner, MSN, patients and remove these barriers.” RN-BC, LNC; and Bayhealth Cancer Institute Medical Director Rishi Sawhney, MD. Bayhealth.org/Nursing
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EMPIRICAL OUTCOMES
Maintaining a Culture of Safety and Quality For Magnet® Redesignation, we must provide nurse-sensitive indicator data, always looking back at the most recent 8 quarters, and demonstrate outperformance of NDNQI benchmarks. From quarter 1 2019 through end of quarter 4 2019, we met (and exceeded) these expectations. The data is accumulative, but broken down in the graph to represent the 2019 calendar year.
CAUTI BAYHEALTH PERFORMANCE AGAINST MAGNET HOSPITAL BENCHMARK 2.0
• The “0” in quarter 4 represents zero CAUTI for all 19 submitting units
1.8 1.6 1.4
• 19 of 19 Bayhealth units outperformed Magnet hospital benchmarks in 6 of 8 quarters through the end of December 2019.
1.2 1.0 0.8 0.6 0.4 0.2 0.0
2019 Qtr 1
2019 Qtr 2
2019 Qtr 3
2019 Qtr 4
CLABSI BAYHEALTH PERFORMANCE AGAINST MAGNET HOSPITAL BENCHMARK 1.2
• The “0” in quarters 2 and 4 represents zero CLABSI for all 19 submitting units.
1.0 0.8
• 17 of 19 Bayhealth units outperformed Magnet hospital benchmarks in 6 of 8 quarters through the end of December 2019
0.6 0.4 0.2 0.0
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2019 Qtr 1
2019 Qtr 2
Patient Care Services Annual Report 2019
2019 Qtr 3
2019 Qtr 4
FALLS WITH INJURY BAYHEALTH PERFORMANCE AGAINST MAGNET HOSPITAL BENCHMARK 0.6
• 18 of 22 units have met or exceeded Magnet hospital benchmarks in 7 out of 8 quarters
0.5 0.4 0.3 0.2 0.1 0.0
2019 Qtr 1
2019 Qtr 2
2019 Qtr 3
2019 Qtr 4
PRESS GANEY PATIENT SATISFACTION: RATE HOSPITAL 1-10 SUSSEX CAMPUS COMPARED TO NATIONAL BENCHMARK, 2019 77 76 75 74 73 72 71 70 69
2019 Qtr 1
2019 Qtr 2
2019 Qtr 3
2019 Qtr 4
• Our Sussex Campus staff impressively increased our overall service level and moved the patient satisfaction needle forward during a year where we moved from one hospital into a brand new facility, complete with new internal and external stakeholder alliances, resultant divergently different workflows, and all the inherent challenges therein. In all quarters, this data reflects us exceeding the 50th percentile in the national ranking.
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BAYHEALTH NEWS & RECOGNITIONS
Collaborations Bring Care Closer to Home The exterior work on the new Nemours Sussex Medical Office building located directly across from Bayhealth Hospital and Outpatient Center, Sussex Campus is complete. Nemours duPont Pediatrics and Nemours SeniorCare will occupy the first floor of the facility. Pediatrics services will include: primary pediatric care; specialty care: allergy, audiology, behavioral health, cardiology, endocrinology, gastroenterology, general surgery, neurology, orthopedics, otolaryngology (ENT), pulmonology, urology and weight management; therapy services: physical, occupational and speech therapy; and diagnostic services: EKG, ECHO, EEG, spirometry, X-ray, and ultrasound. Nemours SeniorCare will provide dental, vision and hearing screening for eligible residents. Coming in 2021, a pediatric urgent care will also open in the Nemours space.
Reaching the Community Through the Airwaves One of the new ways Bayhealth is engaging with community members is through a partnership with WGMD radio, 92.7 FM. Each month, Bayhealth team members join the program during an “on-the-road” show at Southern States in Milford. To date, topics discussed on the show have included flu vaccinations, the new PACE program, medication safety, and classes offered by Bayhealth including the very popular A Matter of Balance series. Tune in to 92.7FM on the second Wednesday of each month at 10 a.m. to hear from Bayhealth experts! 22
Patient Care Services Annual Report 2019
The medical office building will allow Bayhealth to locate more physician practices in one convenient location. On the second and third floors, Bayhealth will house a variety of physician offices including, Women’s Care and MaternalFetal Medicine services. Bayhealth Urology, Otolaryngology (ENT), Endocrinology, Bariatrics, Primary Care, Wound Care, and Dermatology will also be offered on site. A café and community room will be located on the first floor of the Nemours Sussex Medical Office Building. While the facility is expected to open for healthcare services in fall 2020.
&
Wound Care Center Receives National Recognition For the second consecutive year, the Wound Care Center at Bayhealth Hospital, Kent Campus was recognized with the Robert A. Warriner III, MD, Center of Excellence Award. Given by Healogics, the nation’s largest provider of advanced wound care services, the award goes to centers that achieve certain benchmarks.
Bayhealth Recognized with Resuscitation Awards Kudos to Bayhealth team members involved in earning the Get With the Guidelines®-Resuscitation awards by implementing quality improvement measures outlined by the American Heart Association (AHA) for the treatment of adult patients who suffer cardiac arrests at the hospital. The Get With The Guidelines-Resuscitation
program was developed with the goal to save lives by consistently following the most up-to-date research-based protocols for patient safety, medical emergency team response, effective and timely resuscitation (CPR), and post-resuscitation care to treat those experiencing an inhospital cardiac arrest.
Bayhealth Honored with National Stroke Care Awards Bayhealth Hospital, Kent Campus and Bayhealth Hospital, Sussex Campus have received the American Heart Association/American Stroke Association’s Get With The Guidelines® Stroke Gold Plus Quality Achievement Award. Both Bayhealth hospitals are designated as Primary Stroke Centers. The advanced certification they’ve earned from The Joint Commission and the American Heart Association/ American Stroke Association means that Bayhealth maintains high standards in stroke care and is certified to deliver the next generation of care to stroke patients. Bayhealth.org/Nursing 23
Inpatient Rehabilitation Receives CARF Re-accreditation Bayhealth’s Inpatient Rehabilitation has been awarded a three-year accreditation through the Commission on Accreditation of Rehabilitation Facilities (CARF). This accreditation, which was an extension of an already in-place accreditation, extends through Jan. 31, 2022. CARF accreditation is an international program that promotes quality, value and optimal outcomes for rehabilitation programs. Achieving this accreditation signifies that Inpatient Rehabilitation provides the highest quality, value and optimal outcomes for our patients. Inpatient Rehabilitation also holds individual accreditation from CARF as a Stroke Specialty Program.
The Inpatient Rehabilitation Unit treats a variety of patients, including those who have suffered a stroke, spinal cord injury, orthopaedic conditions, amputation, and more. Staff work with patients to address physical and medical challenges, such as mobility issues, self-care, feeding, swallowing, communication, and problem solving. The CARF accreditation is not required of the unit, but Bayhealth has been committed to achieving this recognition for several years.
Celebrating Excellence in Safety Behavioral Health Clinical Nurse Specialist Amanda Fisher, BS, MSN, APRN, AGCNS-BC, CEN, wins the Annual Safety Excellence Award. She was nominated for the work she’s done to build the structure of a behavioral health program at Bayhealth. This includes instituting the Delaware Treatment and Referral Network (DTRN), which is a platform that is an electronic database used in the state for organizations to review the availability of beds for behavioral health/mental health patients. She’s also helped launch a pilot for a Recovery Peer Program, which will put individuals in the ED to help patients suffering from substance abuse.
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2019 DAISY Award Winners January EDKEISHA CESAR (Pictured below right) 2B Ortho
February KELLY MCKENZIE Women’s Services
March HANNAH HASTINGS 4A Acuity Adaptable
April XIANG FANG (Pictured below left) 2B Surgical
August STACI MANNING 2B Surgical
May
September
MATHER SMENKOWSKI Progressive Care Unit
MEGAN WENTLING (Pictured below center right) 4A Acuity Adaptable
GAVIN BROWN Intensive Care Unit
October
December
IDALIS STAMAS 3W Medical-Surgical
DEBORAH TONER 1A Medical-Surgical
July NICHOLE SIGMOND (Pictured below center left) 1A Medical-Surgical
November
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NOTEWORTHY
Bayhealth Hospital Kent & Sussex Campus Re-designated as Baby-Friendly Both Bayhealth Hospital, Kent & Sussex Campus has been re-designated as a Baby-Friendly birth facility in 2019. The international award is given by Baby-Friendly USA, Inc., as part of a global program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) called the Baby-Friendly Hospital Initiative. The initiative encourages and recognizes hospitals and birthing centers that offer an optimal level of care for breastfeeding mothers and their babies. More
specifically, the award is presented to birth facilities that offer breastfeeding mothers the information, confidence, and skills needed to successfully initiate and continue breastfeeding their babies. The Baby-Friendly Hospital Initiative also includes access to education on all methods of effective, safe feeding for infants based on individualized circumstances and choices. The award is maintained by continuing to practice what are known as the Ten Steps to Successful Breastfeeding, as demonstrated by quality processes.
CISM Brings Care to the Caregiver As Bayhealth continues its process to become a High Reliability Organization (HRO), a program known as Critical Incident Stress Management, or CISM, is being relaunched to help fulfill and support the mental health needs of our employees. “It’s a support program that allows a multidisciplinary group of peers to help their
colleagues cope with highly emotional or traumatic incidents. CISM refers to its program as a form of psychological ‘first aid,’” said Director Patient Advocacy, Service Excellence and Professional Recruitment Marianne Foard MS, RN, NE-BC, PRC. Foard says the program was revitalized at Bayhealth with the encouragement from OR staff nurse Steven Tooze, RN, BSN, BA.
More than 20 Bayhealth employees from various departments completed a two-day CISM training and certification course.
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Patient Care Services Annual Report 2019
Driven to Reduce 30-Day Readmissions Keeping patients healthy and out of the hospital is a priority for all hospitals, including Bayhealth. Yet, patients are being readmitted to hospitals at alarming rates. It’s such an issue that Bayhealth has taken a renewed focus on reducing 30-day readmission rates by creating new jobs and building new programs.
everyday life,” Washington said. “We discuss barriers to maintain their health and try to come up with solutions. We’re trying to empower and encourage patients to self-manage their health so we can keep them out of the hospital.”
“The number of times a patient comes back can be mindboggling,” said Readmission Prevention Nurse Jazmine Hamilton, MSN, BSN, RN, CMSRN. She’s working with patients who have been admitted four or more times in a 12-month period. At this point, these high utilizers are the patients Hamilton and clinical nurse specialists focus on. “We meet with them to discuss barriers and what’s missing in the picture in terms of them getting better.” Every morning, Hamilton reviews the readmissions lists and then reaches out to the various clinical nurse specialists to discuss the patient. From there, they meet with the patients and spend time with them to fully focus on the causes of the readmissions. Clinical Nurse Specialist Dennise Washington, MSN, RN, APRN, ACNS-BC, CCRN, focuses on patients with congestive heart failure. “We’re working hard to find strategies that will improve the patient’s quality of life and reduce their readmission. Every time they come into the hospital, it disrupts their
Readmission Prevention Nurse Jazmine Hamilton (left) works closely with clinical nurses specialists like Dennise Washington work together to improve patient care and reduce readmission rates.
Supporting the Southern Delaware Heart Walk It was another successful year for the Southern Delaware Heart Walks. In 2019, Bayhealth raised more than $35,000 for the American Heart Association. This money funds lifesaving research that impacts lives right here in Delaware.
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