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Compiled by | Jordan Colwell, MHA, BSN, RN Contact | Jordan Colwell, MHA, BSN, RN P 308.630.1450 E Jordan.Colwell@rwmc.net 4021 Avenue B Scottsbluff, NE 69361
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Table of Contents A Note From The Editor
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Breakfast with Shirley
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New Staff
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Safety Sense
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Skin Care Note
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Dr. Cornutt Honored
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Air Link CAMTS
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Happy autumn and welcome to this edition of the Magnetic Times! It is that time of year that the Shared Governance Councils will be electing new chairs and chair-elects to their respected councils. It is also that time of year to cordially invite any staff member who wants to make a difference in patient care to join a council.
F. Jordan Colwell F. JORDAN COLWELL, MHA, BSN, RN Survey Preparedness/Magnet Coordinator
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Shared governance has been practiced in hospitals across the country for two decades. If there was one word to describe shared governance, it is empowerment. According to Dr. Tim Porter O’Grady’s article on “Is Shared Governance Still Relevant?” “Shared governance is not a particular design or format; in short, it is not a thing, rather it is a dynamic that is centered on the four critical principles of fully empowered organizations: partnership, accountability, equity, and ownership.” (page 470).
Here at Regional West Medical Center, our Shared Governance Councils strive to meet these four critical principles. It is always amazing to me to see how far these councils grow and achieve from year to year. I know that at times it is gets difficult to “stay the course” due to stalling within the organization, but I am amazed of the perseverance of each council. In this day and age and on this journey of health care overhaul, building a structure for empowerment such as shared governance is not only relevant, it is vital for our continued growth and prosperity. I highly recommend that if you are not involved now, get involved this fall! Yours in health,
Jordan Colwell
We l c o me
New Staff
Nancy Leisy
I am the new Cardiac Rehab Manager. I am from Chadron and transplanted to Alliance, Neb. over 21 years ago. As a nursing assistant way back when (over 26 years ago), I had a wonderful director of nursing who encouraged me to seek a degree in nursing. I pursued this degree in Alliance as a practical nurse and then went on to obtain my degree as a registered nurse. After working with patients in Cardiac Rehab, and wanting to further my education, I sought higher education in the field of Health Education and obtained my bachelors and masters degrees in Health Education as well as a graduate certificate in Health Education. The following year after graduation, I became involved in the national certification process for health educators and became one of 31 nationally certified Health Education Specialists in Nebraska.
I am a new RN in Cardiac Rehab. I grew up in Gering and graduated from the University of Nebraska Medical Center in Omaha with a bachelors degree in Nursing. My mom was a nurse and I just always wanted to be a nurse—in fact in grade school I told my teachers I was going to be a nurse someday. I have two boys so most of my hobbies revolve around them. We like to camp, fish, hike, and play sports. Kara Lemoine
My one piece of advice for a new graduate is that your patient is your number one priority and you can be your patient’s number one advocate. As a new nurse it is easy to be nervous and get wrapped up with all of the activity going on around you but your number one job is to make sure your patients get the best possible care.
I absolutely thrive on watching and helping people progress and get better. I have to thank my caring director of nursing for empowering me to believe in myself to step out of my comfort zone and go to school. I love bike riding, camping, traveling, and cooking. If I could give a new nurse one piece of advice, it would be to try every area of nursing you can—you might find that you like an area you didn’t even know existed!
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We l c o me
New Staff
I am one of the new Clinical Nurse Educators in the Education Department. I am originally from Nampa, Idaho. I started school in Ontario, Oregon where I received an associates degree. After that, I moved back to Nampa where I received a bachelors degree in General Science with a biology emphasis. I then went back to school at Boise State University and received my bachelor of science degree in nursing. Monica Stoddard
When I chose to go into nursing I wasn’t sure what I wanted to do; I just knew I wanted to be in the medical field. I originally received my first bachelor degree to go to PA school but randomly decided to apply to Boise State’s nursing program. After being accepted and now being a nurse, I couldn’t think of a profession that better fits me. Nursing is a very rewarding career and it’s a huge passion of mine. I grew up with horses and they are my biggest hobby. I have done everything from high school rodeo barrel racing to showing reined-cow horses and now I
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competitively team-rope. My boyfriend and I have eight horses and 115 acres where I get my piece of mind. I also love to exercise, swim, and snow ski. It’s so difficult starting out in nursing; my advice to a new nurse would be to never be afraid to ask questions. There will be multiple dilemmas you will find yourself in, both ethical and decisional. Know your resources and believe in yourself enough to know it is okay not to know, just always ask when unsure of something. Everyone was there once! Keep taking care of yourself so you can give 100 percent to your patients who need you the most.
2013 Nurse Resident Graduation
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By Rachelle Noe, BSN, RN, CWOCN Wound Care Nurse
There are currently two topical applications used at Regional West Medical Center to debride a wound with necrotic or slough tissue adhered to the wound bed: Santyl and MEDIHONEY.
debridement and works by quickly softening necrotic/devitalized tissue so it can easily be removed. MEDIHONEY is available in several forms so the dressing may need to be changed every two days or up to every five days.
Santyl The active ingredient is Collangenase. It is applied topically to the wound bed. It helps remove necrotic/devitalized tissue without harming granulation tissue to promote an optimal environment for wounds to heal. Santyl is the only FDA approved chemical debrider available. It is dispensed as a topical gel and the dressing must be changed daily. $130/tube.
$35-$50/tube/box of dressings.
• Santyl is available from our hospital pharmacy and local pharmacies. It is used on our hospital and outpatient clinic patients.
• Provides a moist environment for optimal wound healing.
• Debrides dead tissue without harming healthy tissue. • Provides a moist environment for optimal wound healing. MEDIHONEY MEDIHONEY is a topical wound care product made with Active Leptospermum honey. Studies conducted have found that leptospermum species have a unique plant-derived component that make it ideal for the management of hard to heal wounds and burns. It can also be applied topically to a wound bed that needs
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At this time MEDIHONEY is used on our outpatient wound clinic patients. • Cleanses the wound and rapidly debrides dead tissue. • Helps reduce edema and wound pH.
So if your patient has a wound that needs debridement and he or she is not a candidate for surgical, mechanical, or bedside sharp debridement, then a topical debridement product may be appropriate.
Air Link Receives CAMTS Certification By Joanne Krieg, Marketing and Public Relations Department Regional West Medical Center’s Air Link air ambulance, a rotor wing transport service, was awarded a full three-year accreditation by the Commission on Accreditation of Medical Transport Systems on July 31. The commission (CAMTS) is a nationally recognized organization that ensures that medical transport programs meet national standards for safety, education, and training. Air Link is one of two CAMTS-accredited medical transport programs in Nebraska. It has been accredited since 2001. Nationwide, 154 programs have earned CAMTS accreditation. Patient care and safety are Air Link’s top priorities. The team holds monthly safety meetings that include not only pilots, but mechanics, flight crew, Air Link management, the medical director, security, and facilities. In addition to flight critiques, meetings include educational topics that pertain to safety, such as the use of night vision goggles and reviewing case scenarios. Since November 1995, Air Link has provided highly skilled flight nurse/paramedic teams to care for adult and pediatric patients. The program operates throughout a 150-mile radius that spans western Nebraska, eastern Wyoming, southern South Dakota, and northern Colorado. Air Link has a Bell 407 helicopter, which is operated and maintained by Med-Trans Corporation.
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Attending: Mary Duncan, Kim Kniss, Nancy Ross, Shannon Brown, Shelly Meisner, Suzy Solano, Paul Adams and Shirley Knodel.
Employee Coffee | August 27 Shirley took questions and discussed concerns with members regarding the new Health Care reform law and the challenges that Regional West Medical Center will have in the future. A nurse from Perioperative Services stated that she is noticing a decreasing amount of surgery cases. Shirley said that she is working with the surgeons and Dr. Morgan to even out their time-off schedules so surgery stays consistent. She also mentioned that we need to continue improving our HCAHPS scores. One nurse asked about where we are on the Magnet Journey. Shirley and Jordan Colwell discussed the option of Pathway to Excellence and that the hospital will be pursuing this designation prior to applying for Magnet. This will be a good building block to achieve excellence. Shirley discussed the project that Valley Ambulance and Home Care are conducting to decrease the amount of readmissions. Patients are very receptive of staff members coming in and educating them in their homes.
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A nurse asked why the NDNQI survey does not have a place at the end to add additional comments. Jordan Colwell will research this question for the next survey and follow up with Shirley and staff. A nurse asked how the single patient rooms’ trial is going. Shirley commented that when she rounded on the Medical Surgical floor with their manager, patients really liked it. A nurse asked if we are considering dropping Joint Commission after the survey and applying for another accreditation organization. Shirley explained that after each survey the administration evaluates if they will continue to keep Joint Commission as the accreditation organization. She will share the decision and information with staff once we have completed the survey.
Attending: Paula Staman, Christine Centgraf, Mary Sue Larson, Susan DeBlieck, Marilyn Stoddard, Kadie Marez, Tracey Payne and Shirley Knodel.
Employee Breakfast | September 24 Nurses expressed how excited they are about the new palliative care program that will soon be fully implemented here at Regional West. Nurses expressed concerns with staffing practices. Shirley asked for suggestions on how we can solve the problem. One nurse suggested that we staff on acuity and not on the total number of patients. Shirley mentioned that we have to work on teamwork to retain staff members if that is the problem. Shirley also mentioned that the float pool staff sign up for shifts just like regular staff but will not find out their assignments until the day of. Shirley mentioned that we have a hard time recruiting experienced nurses to Scottsbluff. She hopes that in the future we can continue to work on recruiting experienced nurses to Regional West. A nurse wanted to express a thank you to all the floors for welcoming her when she brings patients from the Patient Care Unit. She stated that when she first started her position, other nursing floors were not welcoming when they got a new patient during their shift, but the attitude has really changed for the better!
and most are in school, then move on to another career. We still strive to recruit enough certified nursing assistants for which we have openings. Shirley mentioned that American Nurses Association has recommended staffing standards for all departments. Those are the standards that lawmakers are using when they are making health care laws. Shirley asked staff if they have problems with the charting system currently being used. The staff all agreed that the charting system is a problem. She invited everyone to the Paragon demos that will take place in October and would like as many clinicians there as possible. Shirley also mentioned that the Paragon program can be used for care plans and acuity modules. It would be the same program that the Physicians Clinic would use. Staff mentioned that it would be nice to have a computer in each room for charting as well as other equipment like automatic blood pressure cuffs. Shirley mentioned that she wants the Unit Practice Council for each unit to work on efficiency on the floors so it saves the staff time (For example, supplies that are kept in the room and computer charting systems).
One nurse has noticed that there seems to not have enough certified nursing assistants in house. Shirley mentioned that there are just not enough career nurse assistants anymore
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Susan Backer SUSAN BACKER, MSN, APRN‑CNS, ACNS‑BC Patient Safety Officer/CNS
Did you know that our top two common causes of error at Regional West Medical Center are Critical Thinking and Compliance? Let’s define both: • Critical Thinking is when the person fails in the cognitive processing of information or in decision making based on information. • Compliance is when the person knows the performance expectation, thinks about it at the time, and makes a choice to act differently. We get this information from our Common Cause Analysis (CCA) data. CCA data is obtained when investigating events that have occurred, such as through Root Cause Analysis and Apparent Cause Analysis. We are using this data to show us where to focus our efforts to prevent errors. So, based on the above information, what tools do we have in our “toolkit,” both staff and leader toolkits, which will help improve Critical Thinking and Compliance? For staff, there are two tools that will help with that: Validate and Verify and Cross Monitoring/Coaching. Both are powerful tools to help us improve and decrease human error. For leaders, the tools that will help improve these areas are Rounding, Coaching, and Fair and Just Accountability using the Performance Management Guide.
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For this edition of the Magnetic Times, the focus will be on the Validate and Verify tool to help improve critical thinking and the Rounding tool to help improve compliance. Critical thinking requires a questioning attitude. Questioning attitude is the single most important critical thinking skill. Questioning attitude is not asking questions, it is learning to question the answers. Question the information you have been given. Validate and Verify (V and V) is a critical thinking tool. The first thing one does when using V and V is to qualify where the information came from. Was it a reliable source? The next step is to validate the information by asking yourself; does this make sense to me? Was this what I expected? Does this fit in with my past experience? If not, then take the time to verify the information. To verify information, we seek out a qualified source. That source may be the medical record, the physician, the charge nurse, a reference manual (drug handbook or laboratory test handbook), the patient or family, policies and procedures, etc. Qualifying the information and validating it are internal checks that take only a couple of seconds. We should ALWAYS qualify and validate the information we have and it only takes a couple of seconds. Verifying information is an external check where we have to physically go and find out if the information is correct.
We always verify in three specific instances: 1. When your internal detector goes off. 2. In every high-risk situation. 3. When there is a change in the patient’s condition or plan. Remember – its okay not to know…It’s NOT okay not to find out.
Here are some conversation tips to help you succeed: • Start by connecting the behavior to a core value (our purposes would be safety), and/or ask a question such as, “Do you know what the top two causes of error are in our organization?” • Assess knowledge and reinforce the specific behavior expectation, such as why, when, and how to use two patient identifiers. Build on their current knowledge.
Leaders play a key role in improving Compliance. There is a quote “We get what we INSPECT,” not necessarily what we EXPECT and that’s where rounding comes in. Rounding is all about engaging with staff at the front line to find out what’s working well and what isn’t working well and to reinforce a specific behavior expectation. In High Reliability language this is called “sensitivity to operations.”
• Identify problems impacting ability to follow the behavior expectations. Ask them, “What makes it difficult for you to verify patient identification using two patient identifiers before providing treatments or procedures?”
Rounding provides the opportunity to:
• Rounding does not magically happen; it must be planned. Schedule time every week to engage with staff through rounding.
• Observe first-hand the work performance of staff as well as other leaders. • Provide real-time feedback and performance coaching. • Through conversation, gain an understanding of employee knowledge of while reinforcing performance expectations of specific behaviors. • Identify problems impacting day to day operations and patient care. Some behavior expectations to target could be: face to face hand-off communication, two patient identifiers, hand hygiene, using SBAR format for communication, customer satisfaction tools, a new work process, and the list goes on and on.
• Ask for a commitment to doing the specific behavior and check back with them to see how it’s going.
Regional West Medical Center is asking all of us, staff and leaders, to use these tools in order to provide a safer experience for our patients. Remember…
Make Safety a Core Value AND Patients First, Every Time
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David Cornutt, MD, Receives Air Link “Guiding Light” Award By Joanne Krieg, Marketing and Public Relations Department
Regional West emergency medicine physician David Cornutt, MD, is the recipient of the 2013 Air Link Guiding Light Award for his contribution to regional emergency health care services. Dr. Cornutt was nominated by members of the Sioux County Rescue Squad in Harrison, Neb., for which he serves as the physician medical director. In nominating him, the crew described Dr. Cornutt as “one of the most caring and generous persons you will ever meet,” and added, “The knowledge and passion this man has for the EMT field and patient care is unbelievable.” David Cornutt, MD
They went on to say: “He attends our monthly meetings, our trainings, and is willing to teach any classes for us. He is available 24/7 for us, no matter what the question or problem may be. He has shared his home phone, cell phone, and work number with all of us, so we feel he is with us at all times.” In a second letter of nomination, Dr. Cornutt was recognized for his commitment to ensuring the squad “follows the Nebraska State EMS Model Protocols to the letter.” Panhandle EMS Specialist Jackie Larrington wrote: “On one particular occasion, which really said a lot to me about his personality and passion for excellence in EMS in Sioux County, he (Dr. Cornutt) drove to Harrison after a
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long ER shift and not feeling well, just to go over some questions and concerns that the rescue captain and I had about their squad and some of its personnel and procedures. He listened very attentively to the questions and concerns and offered very insightful suggestions.” Dr. Cornutt earned his medical degree from Oregon Health Sciences University, Portland, Ore., and completed his residency at Providence Medical Center, also in Portland. He is board-certified in Internal Medicine. Dr. Cornutt joined the Regional West Medical Center emergency department staff in 2010. Prior to that, he served on the medical staff of Providence Portland Medical Center, Portland, Ore., and Willamette Falls Hospital, Oregon City, Ore. As the winner of the 2013 Air Link Guiding Light Award, a $1,000 donation will be made to the Sioux County Rescue Squad in Dr. Cornutt’s name. The donation may be used to provide education and training, or to purchase equipment. The Air Link Guiding Light and Impact Awards were established to recognize men and women who give unselfishly of themselves to further advancements in patient care, both in the pre-hospital and hospital environments.
Shared Governance Nursing Leadership Report August 2013 Coordinating Council New Business Chair and Chair-elect are supposed to be voted on at September meeting, but due to not all chair and chair-elects positions filled, the council will discuss tabling until October. Liz Ossian will chair meeting in September. Pathway to Excellence and Magnet survey data will be discussed at the September meeting. Jordan Colwell announced that there will be no employees from Regional West attending the Magnet Conference in October. This is due to the budget and also the change to pursue Pathway to Excellence. All participants who were selected have been notified as well as their directors. Patient Satisfaction/Communication was discussed and full level of authority was given by Shirley Knodel to Care and Practice Council to work on this project. Old Business Nursing fatigue/meal breaks was revisited and full level of authority was given by Shirley Knodel to the Quality and Safety Council to work on this project. Staff retention/staff scheduling was revisited and full level of authority was given by Shirley Knodel to the Professional Practice Council to work on this project.
Quality and Safety Council (QSC) New Business Christy Jay was elected Chair with Michelle Powell elected as Chair-elect. Old Business The committee decided to begin future meetings at 9:40 a.m. rather than 9:30 a.m. This allows for a better transition between Coordinating Council and Quality/Safety meetings.
regarding the importance of HH compliance and how to implement interventions. The plan is to eventually hand this project over to Infection Control. Nursing Peer Review–(NPR)—Plan to “hand off” to Susan Backer after an initial support period (three months?) during which she and the NPRC may identify additional challenges/ needs.
Professional Practice Council (PPC) New Business Lenna Booth was re-elected as Chair and Nina Palomo was re-elected Chair-elect. Old Business Will continue to work on retention project at September meeting. Projects and Status Clinical ladder work day will be October 11 from 8 a.m. to 5 p.m. in the Keith room. New projects that were discussed with no action taken were nurse mentoring/retention and creative staff scheduling.
Care and Practice Council (CPC) New Business Chair and Chair-elect were not voted on due to low turnout at meeting as well as all nominations were declined by members. Will try to cast vote at September meeting. Old Business Fall Prevention Program Projects and Status The council continues work on the house-wide launch plan including staff education, informatics request, and transition to an organization-wide, multidisciplinary Falls Team. 3rd Floor is currently working on completing the training and launched August 19.
Projects and Status Hand Hygiene—Additional education at 2nd and 3rd floor UPC meetings this month
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Shared Governance Nursing Leadership Report Night-Shift Council (NSC) New Business Chair and Chair-elect were not voted on due to low turnout at meeting as well as all nominations were declined for Chair position. Will try to cast vote at September meeting. Old Business Med pass changes have been made. This will reduce the number of “missing/stolen” doses. Please send a missing dose form if necessary so Pharmacy can track the frequency of missing doses. Projects and Status Discharge planning was discussed as a new project and finalization of plan will occur at September meeting.
Nurse-Finance Council (NFC) New Business Paul Adams and Amy Holzworth were elected Co-Chairs. Procedure for bringing new ideas to the Council was discussed and will be finalized at the September meeting. New items: hospital menus in patient care rooms; IV tubing. Old Business Overtime report discussion: Scott presented report that showed breakdown by nursing area and included consideration of patient census/utilization. Status updates for non-disposable blood pressure cuffs and pulse oximeters–Rapid Cycle testing discussed. Poster campaign for standardized IV kit/tray.
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Projects and Status Blood pressure cuffs: Paul Adams will help with a rapid cycle test on 3rd floor. Data will be reported at the next meeting. IV kit/tray: Small group will meet with Marketing to work on posters showing cost per item on the tray/kit. Overtime: Tami Bokelman will be observing clock in/out times/practices for the ARU and report back to the council.
Break for Excellence Lunch
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