2014 Nursing Annual Report
Table of Contents
Compiled by Jacqulyn Robison, BSN, RN, GRN Contact Jacqulyn Robison, BSN, RN, GRN P 308.630.1450 E Jacqulyn.Robison@rwmc.net 4021 Avenue B Scottsbluff, NE 69361 rwhs.org
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Message from the CEO................................................................. 3 Message from the CNO................................................................ 4 Shared Governance/Pathway to Excellence ................................... 5 Snapshots from 2014 Breakfasts with Shirley................................ 6 2014 Nurses Day Award Winners.................................................. 7 RN Magnet Awards....................................................................... 8 2014 Star Awards Presented to Nurses....................................... 10 Patient Safety............................................................................ 12 Behavioral Health ...................................................................... 16 Acute Rehabilitation .................................................................. 17 Medical Surgical Services........................................................... 18 Birth and Infant Care Center and Pediatrics.................................. 20 Clinical Rescue Team, House Supervisors, Dialysis, Language Access, ANSOS, and Wound Clinic............. 22 Wound Care/Ostomy.................................................................. 23 Perioperative Services................................................................ 24 Operating Room (OR).................................................................. 24 Outpatient Surgery (OPS) and Perianesthesia Care Unit (PACU)............................................. 26 Scottsbluff Surgery Center (SBSC).............................................. 28 Endoscopy and Pre-Admit Testing (PAT)........................................ 29 Critical Care and Emergency ...................................................... 30 Air Link Transfer Center.............................................................. 34 Home Care and Hospice............................................................. 36 Imaging Services........................................................................ 38 Cardiac Cath Lab........................................................................ 39 Cardiac and Pulmonary Rehabilitation.......................................... 40 Case Management..................................................................... 41 Community Health...................................................................... 42 Pharmacy Medication Reconciliation Nurses................................. 44 Quality Resource........................................................................ 45 Fall Prevention Team.................................................................. 46 Risk Management...................................................................... 48 Trauma Services........................................................................ 49 Education ................................................................................. 51 Shared Governance.................................................................... 52 Certified Nurses......................................................................... 58
CEO Message Greetings, As we initiate the year 2015, Regional West has been focused on three major initiatives. •T he first is to work collectively to improve patient quality outcomes, patient safety, and patient satisfaction. •T he second is to enhance efficiency with our provision of health care services. •T he third is to improve growth opportunities and enhance regional relationships and partnerships with hospitals and communities. Regional West has a history and track record of providing high quality patient care services to patients that we are privileged to serve. It is remarkable from my standpoint how Regional West continues to be a very successful acute care referral center covering a large geographic region. We believe high quality health care services should be provided locally, when possible, for patient convenience and safety. Our goal is to continue and expand on our success. As we prepared the operational plans for 2015, we identified the number one priority for Regional West is to improve, when possible, the provision of high quality patient care services to our patients. As we continue to focus our energy on improving patient outcomes, patient satisfaction, and patient safety, these were in the forefront of our discussions in the everchanging health care environment as we look forward. We have many ongoing activities for Regional West this year, including: new program developments; enhancing access to our providers in Scottsbluff and other provider
outreach in key locations in the community; striving for clinical excellence recognition; enhancing our partnership with area providers to include physician support, quality support, and other support services; and continuing to work hard to not retract our focus on improving patient safety and quality care. Regional West will also be working with other area organizations to enhance our ability to provide high quality care services in the region. Some of these groups include the Regional Provider Network, Nebraska Hospital Association, Voluntary Hospitals of America, University of Colorado Health/Poudre Valley Health System, and others. We believe that having these relationships are very important and will help strengthen our ability to continue to provide excellent patient care services.
John Mentgen, FACHE President and CEO Regional West Health Services
We also will be focusing on the development, evaluation, and potential implementation of an electronic health record (EHR). This is essential for our ability to provide effective patient services going forward. We are committed to determine the best course of action for us and our partnerships in 2015. All of the items that we are concentrating on this year are not possible without our high quality staff. Clearly, your commitment to excellent patient care services enables us to continue to be successful today and in the future. Through the ever-changing health care environment, it is the dedication that you bring in providing our services that will continue to move us forward successfully as an organization. Thank you again for all that you do for our patients at Regional West. John Regional West Health Services | 3
Message from the CNO This has been a year full of milestones. At the time of this writing, Regional West has gone nearly a year without a serious safety event. This is an accomplishment that takes everyone’s participation and teamwork. Taking care of every patient every time the way that we ourselves would want to be treated is what differentiates Regional West from other organizations. Additionally, we have accomplished great strides in our patient satisfaction scores related to nurse communication. Consistent use of the AIDET communication tool has improved patient satisfaction with our communication. Quality, efficiency, and growth are the three key strategies Mr. Mentgen, our new CEO, has laid out for Regional West. Each of us plays a part in these strategies. We need to ask ourselves always, “What is in the best interest of the patient?” If we focus on that, patients will notice.
Shirley Knodel, RN, MS Chief Nursing Officer | Vice President Patient Care
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We need to be efficient, wise stewards of our resources, eliminating wasted supplies, wasted steps, and wasted time. In order to grow, we need to make it convenient for patients and
families to access our care. We need to make it easy for the other hospitals and providers in the panhandle to access our services. We all want to see Regional West be a vibrant, thriving health care system that meets the needs of the people of the panhandle. Together we can continue to grow and constantly strive for improvement.
Shared Governance/ Pathway to Excellence 2014 held some excitement and growth for the nursing staff of Regional West Medical Center, as well as the Shared Governance groups and Unit Practice Councils. The goals for Shared Governance are to have evidencebased practice driven by the frontline nurses in order to reflect nursing satisfaction, patient satisfaction, and quality of care provided to patients. During 2014, the following Shared Governance Councils worked diligently to provide nursing-led change to our organization: Coordinating Council, the Quality and Safety Council, Professional Practice Council, Care and Practice Council, Nurse-Finance Council, and the Night Shift Council. In previous years, Regional West had a vision of obtaining the ANCC Magnet Accreditation and since I started in 2014, the direction has changed to the ANCC Pathway to Excellence Accreditation. During this time the decision was made that 2015 would be the year to prepare our submission data and follow the 12 steps in achieving Pathways so that when January 1, 2016 arrives, we will submit the application and succeed at achieving the ANCC Pathway to Excellence designation. This seems like it is such a long time away, however, looking at 2014 there have been a multitude of changes come our way. They range from the start of the Paragon build, an introduction of a new CEO, the Affordable Care Act implementations, revisions in federal guidelines, and the influence of patient satisfaction scores with hourly rounding accountability. However, even though transformations have been very evident, the nursing staff has still done well to celebrate their success and appreciate they team members. The Nurses Week celebration went well with a variety
of nurses and support staff who were chosen for the different Magnet nursing awards. During the fall, the Nursing Administration department successfully hosted the “Health Care Celebration Speaker Day,” which allowed all interdisciplinary team members to attend and enjoy our humorous speaker, Karyn Buxman, who has a nursing background. Please enjoy the rest of this nursing report and see what the different units have accomplished as well as the Shared Governance Councils.
INSERT MAGNET MODEL
Jacqulyn Robison, BSN, RN, GRN Survey Preparedness and Magnet Coordinator
“ The secret of change is to focus all of your energy, not on fighting the old, but building on the new.” — Socrates
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Snapshots from 2014: Breakfast with Shirley
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2014 Nurses Day Award Winners Friend of Nursing Award Jeanette Weimer, Unit Secretary, 3rd Floor “She is a helping hand, always there to help the nurse with other projects that are going on during the day, answering the phones, and helping all staff throughout the day. Answering questions, being polite to others, never complaining, and constantly training all the new staff. She is a tremendous help and resource to our staff and we would not be able to do what we do without her help. She has a positive attitude, is always smiling, dresses professional, and helps everyone from staff to visitors.”
Friend of Nursing Award Josh Lively, BS, RT (R)(VI), Special Procedures Tech in Interventional Radiology “Josh is very deserving of the Friend of Nursing Award because he exemplifies being a team player in all aspects of his work.” “Nurses in Imaging Services work in a tech-driven world. Teamwork is essential to maintain a safe environment, with the best possible outcome for our patients, while obtaining the best possible images with the least possible radiation exposure.” “He has instituted an Interventional Shared Governance Group where we meet to discuss issues/ processes. This encourages everyone’s involvement and increases morale. He is excellent at keeping the meeting on task, without blame so we can learn from each other and better ourselves and our team. Josh is one of our greatest assets and deserves to win this award.” “He is an excellent source of knowledge and is always willing to take time to explain procedures, location of interventions, and answer any questions that are brought to him. Josh has also been invaluable in helping with the new computer system we have in the angio suite.” “He never takes his frustration out on those around him, providing a calm voice of reason when things get hectic.” “Josh is not only a patient advocate, but also advocates for our nurses. He is extremely good at seeing the whole picture and proposing solutions that meet the needs of both nurses and technologists.”
Outstanding LPN Sandra Schwartz, LPN, Birth & Infant Care Center “Sandra is an extremely well organized, team-playing nurse, who is a wonderful asset for our unit. Her patients love her, and prove that by recognizing her frequently with STARs and comments in follow-up calls. I appreciate her thoroughness in her assessment skills and her dependability when working with her on the unit. In one particular case, an infant who had been on the unit for a few days was getting ready to go home, and Sandra just didn’t feel like the babe “looked right.” She insisted on further investigation by an NICU nurse and for more follow up by the physician. This baby needed more intensive care than Regional West could offer and was transferred to Denver for immediate surgery. Had Sandra sent that family home, that infant would have died.” Regional West Health Services | 7
RN Magnet Awards Empirical Outcomes Melissa Amateis, RN, Emergency Department “Melissa’s positive attitude is contagious. Melissa takes her job seriously but has committed to the unit positivity initiative. As a charge nurse, Melissa ensures an environment that contributes to the well-being of staff and patients. Safety is imperative to Melissa. She speaks up for safety concerns and has been a driving force for improving the Emergency Department’s security and telemetry monitoring. Melissa seeks to improve herself daily. She is an active member of the Emergency Nurses Association and holds certification in her specialty. Staff members in the Emergency Department look to Melissa as a mentor and friend. She continues to strive to make Regional West Medical Center’s Emergency Department a place for the community to come for excellent care.”
Exemplary Professional Practice Ellen Otto, RN, Interventional Radiology “Ellen is a superior nurse as evidenced by her love of the patient and commitment to continued nursing. She is patient centered, taking into account the family/support system each patient has.” “Ellen works well autonomously, yet maintains the teamwork attitude that is important for patient safety, department function, and morale. She considers coworkers’ strengths, including non-nursing personnel, when making decisions. Her communication with other departments is always clear and concise.” “Ellen is an integral part of our department, helping all to be more conscientious of not only our own skills, but patient outcomes.” Thank you, Ellen!
Transformational Leadership Josh Beals, RN, ICU “Josh leads by example, creating a positive team-based environment with the common goal of patient advocacy. Josh offers a sense of non-wavering support for staff and patients by being highly visible and accessible. These exceptional qualities, paired with his strong emphasis on communication at every level of patient care, make Josh the ideal candidate for Regional West Health Services 2014 Outstanding RN in Transformational Leadership.” “A true educator at heart.” “Rarely will you find one of Josh’s team members “sinking” or falling behind. His ability to recognize an overwhelmed staff member, and act expediently, is the ultimate sign of support for both staff and patients.” “Josh places a strong emphasis on communication at every level of the patient’s care. Josh’s success in effectively corresponding with patients, staff, and physicians is largely due to his singular ability to listen. Josh also has an uncanny ability to resolve conflicts, by listening carefully to all facets of the situation.”
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New Knowledge, Innovations, and Improvement Gillian Allen Blaha, RN, ICU “[Gillian’s] compassion for patients is second-to-none and is demonstrated in every aspect of her care. It is Gillian’s compassion and exemplary bedside manner that has made her a favorite among many patients and a fine candidate for any of all five components. Gillian is truly a student of her practice. As a member of American Association of Critical Care Nurses, she is constantly evaluating the newest research available to provide the safest and best care for our patients. She has an uncanny ability to analyze our current unit’s practice and draw from her knowledge in evidence-based practice to generate new policy for the unit and educate new knowledge to the staff. These qualities have been key to Gillian’s success in the ICU and have assisted her in helping implement large-scale changes in the unit’s practice in the form of an ABCDE Bundle for ventilated patients.” “Ultimately, the changes have led to better care for our patients. Patients are now ambulated very early on, even while on a ventilator, resulting in a reduction in ventilator days and ventilator associated pneumonia.” “Gillian’s work ethic and willingness to promote change can inspire all ICU nurses to say proudly that we are at the forefront of critical care!”
Structural Empowerment Brooke Dollarhide, RN, ICU “Brooke promotes a positive work environment and has earned great respect from her fellow employees. However, Brooke’s impact on the unit goes beyond her “daily” tasks of a nurse. As the chair of the ICU/PCU’s Unit Practice Council, Brooke has been pivotal in creating a system of self-governance for the unit, which has decision making capabilities.” “One of Brooke’s greatest qualities is her dedication to professional growth, both personally and for the unit as a whole. Brooke is eager to promote best patient care utilizing the latest evidence-based practice. Working closely with Gillian Blaha, Brooke helped implement the ABCDE Bundle, which focuses on early awakening trials for ventilated patients, spontaneous breathing tests, coordination between care providers, a standardized delirium assessment program, and early mobilization.”
Outstanding Preceptor of Nursing Students Becky Avila, RN, Emergency Department “Becky was the first nurse through my two years of clinical experiences who questioned me and made me truly think through the process of WHY we were performing our interventions and care and not just the process. Anyone can teach a process or follow step-by-step instructions, but it truly takes a knowledgeable nurse who cares and can communicate with the student to ask the probing questions to stimulate critical thinking. Becky is a great leader and role model and is someone that student nurses should strive to emulate.”
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2014 Star Awards Presented to Nurses Lois Cannell, RN, Case Management “Lois is a Shooting Star because of her constant display of amazing and respected teamwork and professionalism. Lois is quick to call co-workers in other areas to give them updates that will impact their workflow. She takes the time to work with physicians and doesn't hesitate to direct them to the right area or call the right person in an effort to make that doctor's day run a little smoother. She is quick to include the CDI team with changes and updates on the patients in her unit. Lois understands the challenges that the CDI team faces with our query process, and won't hesitate to help; whether it is a quick phone call letting us know a physician is on the unit, or to just sit down with the physician to help explain a query. Lois maintains a professional attitude towards teammates and staff, and goes above and beyond her regular assigned duties without hesitation.” “RN case managers are scheduled to work weekends. Sometimes the weekend person can't work and we scramble to cover the days. Lois is always the first person to volunteer – with a smile.”
Glenda Davis, RN, Rehab Center “Glenda is not only very professional in her manner, but she also knows the importance of being friendly and kind to each patient. Glenda’s smile, warm “hello,” and interest in each patient’s daily life, including general health and exercise, enable the patients to work on becoming mentally and physically healthy. I felt extremely reassured that Glenda was very knowledgeable in her professional field and she always was prepared to share a wealth of cardiac information. Glenda’s level of nursing expertise was evident every day. She made patients feel at ease and comfortable with the exercise machines and always had the best interests of the patient in mind. I had complete confidence during the workout session that I was being closely and professionally monitored. Over the years, Glenda has undoubtedly helped many patients reach their goals to improved cardiac health by teaching life-long health practices, the importance of exercise, and good nutrition. I therefore nominate Glenda as an outstanding STAR at Regional West Medical Center. I sincerely thank you for your time and consideration in nominating Glenda as a STAR.”
Sandy Hebbert, RN, Recovery Room “Please excuse my tardiness in writing this letter to recognize your surgicalrecovery nurses that took care of me when I had a total hip replacement. When I was being prepared for surgery, all the nurses as well as the anesthesiologist made me feel safe, secure, and well cared for. After my surgery, while I was waking up in recovery, I remember that at one point I started to cry, and one of the recovery nurses asked me what was wrong and why was I crying? I remember telling her that I wanted to wear my "tiara" when I woke up in recovery and that I'd forgotten it at home. I can't recall her name, but she knows who she is, stepped away for a bit and came back to my bedside with a handmade "tiara" that she put together using a paper plate cut into the shape of a crown. She glued on some colored stones to look like gemstones, and put it on my head using a rubber tourniquet to hold the crown in place!!! I told her my name is 10 | Nursing Annual Report
Diana, like the princess, but I'm too old to be the princess and that now I'm the queen!!! I remember when they were taking me up to my room, this little gal told me to wave like the queen does so I remember waving at all the people we passed!!! Long story short, I've told everyone about her and how sweet she was, and I've kept my tiara. She didn't have to be as attentive as she was, but her concern really made me happy!! I'll be needing my other hip replaced in the future and I pray I get her as my recovery nurse again!! You are so lucky having her on your staff, as are her patients having her as their nurse!! Everyone involved in my care was the best! Dr. Friedlein did a great job with regard to my surgery, he too was very attentive! I will go to Regional West for all my medical needs in the future!!”
Connie Kirchner, RN, Endoscopy “Connie helped us after a colonoscopy with comfort and hugs. She stayed with us as long as we needed, and was so concerned about our welfare. We even received a card in the mail. Her kindness went beyond the care we received.”
Connie Morrill, RN, 2 East “Connie is truly a shining star, goes above and beyond her nursing duties, and has a great attitude. I enjoyed her so much.” “Realizing that the person in the hospital is not a nurse’s only patient! There are so many dedicated, caring, competent individuals at Regional West it almost seems inappropriate to recognize any as exceptional. It is also true that the harried pace of the day shift prevents as much patient contact as can be given overnight. The lonely, sometimes frightening hours in the dark make people reach out for comfort, and it was then that we found Connie Morrill, RN. Connie was able to explain how each machine was to be used for its optimum value and adjust each so it was as comfortable as possible. She was very complimentary of others on the staff and shared her big smile and laugh to help us know we were in caring, competent hands. I had been having trouble sleeping each night, waking with worry. Connie said “If you wake up and want to come back, please do!” but knowing my mother was in Connie’s care that night allowed me to have a peaceful eight hours of sleep. Thank you, Connie!” “An excellent nurse and person. She took great care with me and made sure I was comfortable. Explained the things that were going on medically with me and explained what the meds do for me. Great personality and very kind person.”
Darla Novotny, RN, 3rd Floor “About a month ago my mother, Alice Keller, was in Regional West Medical Center and passed away. I wanted to let you know that although losing someone is always very hard, it was made much easier for us by one of your valuable nurses. Darla Novotny on the third floor was so good with Mom and all of us. She explained what was happening and answered any questions we had. What impressed me most was how she came alongside my niece who is a nursing student. She took her under her wing and TAUGHT her as the process of death was unfolding. I know it will be an invaluable experience for my niece, whom I am sure will be an excellent nurse like Darla. Thank you for hiring Darla at Regional West. I cannot express enough my thanks to her for her fine work and wonderful demeanor.” Regional West Health Services | 11
Patient Safety 2014 has been a great year for Patient Safety and Patient Services. Our last Serious Safety Event (SSE) was in February, making our year-end Serious Safety Event Rate (SSER) 0.18—the lowest it’s ever been. Great attention to safety by everyone in the organization! Following are the 2014 activities designed to promote patient safety and working together in teams at Regional West Medical Center with a brief overview of the work done in 2014 and continuing into 2015.
Safety Trainers We continue to have a dedicated team that provides Safety Behavior Training to new hires on their first day of orientation. They are: Sylvia Dolberg, Sean McCracken, Michelle Powell, Karna Kleager, Linda Fowler, and Susan Backer. This group has been doing this training since we started at the beginning of 2011. Julie Schaff and Susan Backer continue to provide Susan Backer, MSN, APRN-CNS, Leader Safety Behavior Training to new leaders at all levels once a ACNS-BC | Clinical Nurse Specialist/Patient Safety Officer quarter. All of these trainers do an excellent job and I appreciate their commitment to patient safety.
Safety Coaches We have 45 active safety coaches. The safety coach role is to partner with his or her manager and director to help build and reinforce accountability for using the safety behavior tools. We met six times in 2014 with a focus on specific behaviors/topic for a two-month period:
Due to low hand hygiene compliance numbers, this topic was the target starting in July. We focused on providing education on when and how to perform hand hygiene and the importance of cross monitoring to help each other do the right thing. The expectation was set to share the data with all staff. By end of the 3rd quarter, most departments showed improvement and we will continue to work towards a 90 percent compliance goal. Great job to everyone!!
MyCRU In September we introduced MyCRU, a teamwork model for working together to provide safe, high quality care to patients. CRU stands for Cooperative, Respectful, Unified. These are characteristics that are important in a wellfunctioning team. The MyCRU toolkit will be introduced starting in January 2015. It is based on 5 Tones to reduce power distance and manage authority gradient and
Safety Behavior Tools
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January/February
Speak-Up for Safety
March/April
Hand-Off Communication
May/June
Attention to Detail
July/August
Hand Hygiene/Communicate Clearly
September/October
Hand Hygiene/Teamwork(CRU)/ Wingman Recognition
November/December
CRU – 5 Tones/Hand Hygiene
5 Tools for evidence-based human error prevention. The tones are the non-verbal part of working together. If we are to work together and think together as a team to keep our patients safe, we must feel safe to share our thinking, ask questions about others’ thinking, and speak up for safety. The tones were built from Regional West Health Services Standards of Behavior (policy #205.0.01). The MyCRU tools are tools that we have already learned, plus a few more to help us work together more effectively in teams. The tools are simple, and all have been done by everyone at some time or another. The tools are grouped together in sections to help us maintain situational awareness, lead the team, communicate clearly, think critically, and speak up for safety.
Wingman Recognition The Wingman Recognition program was initiated September 1 through December 31. “Never leave your wingman” is a phrase borrowed from naval aviation. The wingman positions his/her aircraft outside and behind (or on the wing of) the fighter pilot and is tasked with protecting the fighter pilot while he or she is engaged in combat. The wingman is also responsible for alerting the fighter pilot of trouble. Simply put, a wingman has your back! In the air and at Regional West, a wingman is more than a peer or a fellow employee – your wingman helps keep patients safe by providing: •C ross Monitoring to prevent a co-worker from making a mistake.
• On the spot second opinions. •P ositive feedback to reinforce safe behaviors. The wingman recognition program gave everyone the opportunity to recognize someone for being a team player—for being their wingman. There were 77 wingmen recognized over this four month period. The recognitions came from many different departments and professions. You can view these recognitions on the Campus Homepage<Safety Culture Initiative (left hand side of the home screen)<the electronic Wingman Photo Album will appear. Marketing did a great job putting the wingman photo album together. It was tremendously rewarding to participate in helping others recognize someone for being a team player and functioning as their wingman. We plan to repeat this recognition program in late 2015.
Climate of Patient Safety Survey In January 2014 we completed the Climate of Patient Safety survey. In the past, the survey was conducted through the VHA Mountain States. However, since this VHA group no longer exists, we took the opportunity, starting in late 2009, to utilize a different survey from the Agency for Healthcare Research and Quality (AHRQ) that better assesses the safety culture work we have done. The survey was distributed via Survey Monkey to Regional West Medical Center staff and providers who provide patient care or supervise a clinical unit. The survey was distributed to 726 individuals. There were 554 responses received, representing a 76 percent return rate. Regional West Health Services | 13
The AHRQ hospital survey on patient safety culture is designed to measure four overall patient safety outcomes and ten dimensions of culture pertaining to patient safety.
Four overall patient safety outcomes 1. Overall perceptions of safety 2. Frequency of events reported
•M edical Surgical Services (2E, 2W, 3E) - Shift to shift bedside report •N urse Residency - varying topics of low and high fidelity simulation
4. Communication openness
The clinical coordinators completed the Simulation Education Modules through the National League of Nursing (NLN) Simulation Innovation Research Center by April 1. This education was valuable in helping these front line educators develop and initiate meaningful learning simulations in their area. Though we are novice at simulation, we continue to move forward to identify and implement interdisciplinary simulation opportunities.
5. Feedback and communication about error
Quality & Safety Shared Governance Council
6. Non-punitive response to error
The Health Care Worker Fatigue Survey was developed and administered by the Nursing Shared Governance Quality & Safety Council. Shift length, number of consecutive shifts worked, and breaks were the focus of the project. Two surveys were created, one for direct care staff and one for managers and directors. Targeted participants were those working in patient care/clinical areas with 24/7 operations. Departments that chose to participate were:
3. Number of events reported 4. Overall patient safety grade
Ten dimensions of culture 1. Supervisor/manager expectations and actions promoting patient safety 2. Organizational learning— continuous improvement 3. Teamwork within units
7. Staffing 8. Hospital management support for patient safety 9. Teamwork across hospital units 10. Hospital handoffs and transitions Based on survey results, work is being done on recognizing staff who utilize safety tools and contribute to changing the safety culture: hand-off processes, leadership training, and staffing and patient flow. Much of this work will continue through 2015. Survey results can be reviewed on the Campus Homepage<Quality Data (left hand side of the homepage)<Climate of Safety Survey<Powerpoint titled “Climate of Safety Presentation.”
Simulations for 2014 included: • ED/ICU - Code Blue in PET Scan and MRI • Surgery - Cardiac arrest, Fire in OR 14 | Nursing Annual Report
• PACU - Malignant hyperthermia
• Float Pool/House Supervisors • Imaging Services • Pharmacy • Cardiopulmonary • HomeCare/Hospice • Adult Post-Surgical (2W) • Ortho Neuro (2E) • Medical/Oncology (3E) • Acute Rehab Unit (4E) •P erioperative Services (including Surgery Center and Endoscopy) • Pediatrics
• Birth & Infant Care Center • Neonatal Intensive Care Unit (NICU) • ICU/PCU • Emergency Department There was 64 percent participation by direct care staff and 74 percent participation by managers/directors. Results are available on the Sdrive<RWHS_SHARE_ Shared_Governance<Quality & Safety<Health Care Worker Fatigue Project<HC Worker Fatigue Survey Results ALL (eXcel file). An action plan is currently being developed by the Quality & Safety Council. This work will continue into 2015.
Nursing Peer Review Committee Nursing Peer Review Committee started in late 2012. There is a dedicated group of direct care RNs from the Emergency Department, ICU/PCU, Perioperative Services, BICC/NICU, Adult Post-Surgical (2W), Ortho/Neuro (2E), Medical Oncology (3E), and Acute Rehab who actively participate on this committee. Over the last two years the committee has reviewed a total of 27 cases. As a result of these reviews, there have been many improvements in nursing care and processes.
Nursing Policies & Procedures About three years ago, the Patient Services Division purchased Mosby’s Skills for the most updated and evidence-based nursing procedures. This is a highly valued resource that helps us keep our procedures current based on research evidence. One contribution this committee has made is getting job aides posted on the Campus Homepage just beneath its corresponding procedure. This provides nursing with quick and easy access to procedural information without having to search through the procedure itself. To continue
providing easy access to nursing procedures by direct care staff, we have started posting departmentspecific policies/procedures on the Intranet, along with the general nursing policies/procedures. By the end of 2014, the Emergency Department documents were added for access through the Intranet. More units will follow in 2015.
Common Competency Days For the first time, the patient care areas worked together to host competency days for direct care RNs and LPNs. This effort was led by the Clinical Coordinators Group: Alice Fillingham, Linda Fowler, Rhonda Groshans, Stacey Powell, Pam Cover, Tammi White, and Kim Meininger.
Competency stations included: •T rach rescue •C hest tubes—new pleurovac •B eds and bed surfaces •C -Collar—new •C PM machine—(continuous passive motion ) •S Q access for medication administration • SQ hydration
“ Alone we can do so little. Together we can do so much.” – Helen Keller
• Ventriculostomy set up • Level I blood administration •C ode simulation—ACLS and BLS • Plum A+ infusion pumps The event was hosted in September with several dates and times made available to nursing care staff. Because this event was so successful, plans are being made to organize common competency days again in 2015. 2014 was a busy year with much accomplished. I would like to thank all the people who work hard to provide safe, high quality care to the patients we serve.
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Behavioral Health Behavioral Health Care has been hit hard over the last few years by decreasing lengths of stay and shrinking reimbursement. Nebraska state reimbursements, as well as Medicaid dollars for Behavioral Health Services, are closely managed. Over the past two to three years we have seen a dramatic decrease in approved patient days for Behavioral Health Services. The impact on our Behavioral Health Unit has caused a steady decrease in average daily census. In January 2014 a decision was made to downsize, or as some say, “right size” the unit. As a result, the unit went from 18 beds to 12 beds and six staff positions were eliminated. The end result of these changes challenged the remaining staff to redesign work processes in order to maintain quality and safety with fewer staff resources.
Mary Armstrong, RN Director Behavioral Health Unit
The transition has not been easy but I am continually amazed by the commitment and sheer resilience of the Behavioral Health Unit staff. They have made many changes and have worked very hard over the last 12 months, but have continued to provide high quality services to mentally ill patients in a caring and dignified manner. Regional West Medical Center’s administrative team has been a strong advocate for the ongoing provision of Behavioral Health Services by the hospital and have joined forces with Behavioral Health Leadership and Region 1 to petition the state of Nebraska to address the financial hardships experienced by the hospital as well as other providers of Behavioral Health Services in the panhandle as a result of state legislation. In the midst of all this change, we also continued to monitor and work on the following key issues: • Reduction of patient falls by utilizing the Hendrich II fall tools • Improving patient satisfaction through the utilization of AIDET • Increasing patient and staff safety by utilizing safety tools
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• I mproving compliance with Psychiatric Core Measures and regulating agencies As I write this, I am beginning the last three months of 18 years as director of Behavioral Health Services and 32 years as an employee of Regional West Medical Center. I am so fortunate to have had the opportunity to work for such a fine organization. It has also been a distinct privilege to work with Dr. Michael as medical director and the wonderful staff on the Behavioral Health Unit. In April 2015, Tami Bokelman, the current director of the Acute Rehabilitation Unit, will take my place as Behavioral Health director and Penny Thomas will assist her as Behavioral Health unit manager. The Behavioral Health Unit is extremely fortunate to have two professionals like Tami and Penny to lead them in the future. As health care continues to evolve there will be many more changes on the horizon but I am confident that Behavioral Health Services and Regional West Medical Center will be proactive and meet the challenges head on.
Acute Rehabilitation 2014 brought change and growth to the Acute Rehab Unit (ARU). As the previous medical director left the ARU to be closer to family, Robert Nelson, DO, joined the team in July to be our new leader. He was raised in Henry, Neb., and is a graduate of Chadron State College. In 2010, he earned his medical degree from Midwestern University, Arizona College of Osteopathic Medicine in Glendale, Ariz. In 2014, he completed his residency in Physical Medicine and Rehabilitation at the University of Texas Health Sciences Center, San Antonio. He has been a wonderful addition to the unit. Since he has been on board, the unit has seen growth in the areas of admissions and average daily census. He brings a patient-centered philosophy and his enthusiasm is contagious. Our Patient Advisory Council continues to be very active with advocacy efforts regarding accessibility within the hospital and the community. At their meeting in April, they were given the opportunity to speak to the media about their efforts. The council continues to grow by adding new patients/ family members, with our last meeting having 11 members at the table. They continue to provide peer support to our current patients and families. Out of a recommendation from a member of the Patient Advisory Council, we were able to begin a new Amputee Support Group. Organized by Bobbi Turner, LPN, the monthly meetings offer time for discussion and presentations from a variety of guest speakers who will address topics of interest to those who have experienced amputation, their spouse, and/or support person. The group’s mission is to provide a safe environment for sharing of ideas, needs, and emotions with persons who have limb loss, and to empower participants through education, support, and advocacy. Patient satisfaction continues to be a focus for all ARU staff. Through consistent review of our results at
monthly staff meetings, we have identified our focus areas and the staff has actively identified interventions that we can all use to help improve our scores. Leadership rounding is also done consistently on the unit, and all results are shared with the staff through a weekly written report. This year marked our fifth CARF (Commission on Accreditation for Rehab Facilities) accreditation survey for the Acute Rehab Unit. The unit was surveyed for two days in October for Medical Rehabilitation and the Stroke Specialty Program. The unit was awarded the highest accreditation of a three-year period. The unit was commended in many areas, including leadership and unit staff, medical direction, interdisciplinary team communication, strategic planning, Stroke Specialty Program, and fall and injury prevention. The report states, “It is obvious that ARU fosters a caring, professional, and person-centered environment. All staff members seem committed to the care, satisfaction, and wellbeing of those entrusted to their care.” Thank you ARU staff!!
Tami Bokelman, MSW | Program Director
Pam Cover, RN, CRRN | Nurse Manager
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Medical Surgical Services Medical Surgical Services is a dynamic area of nursing care and interdisciplinary care that includes the three medical surgical units, the vascular access team, and the bariatric coordinator. Within the overall umbrella of medical surgical are the specialties of Orthopaedic/Neurological Post-Surgical Care, General Adult Post-Surgical Care, General Medical Care, and Oncology.
Diana-Jean Baratta, MSN, MA, RN | Director, Medical Surgical Services
The Medical Surgical Services Department has operated as a unified whole striving for respectful and caring communication, both to our patients and to each other. We have continued efforts to allow each patient a private room until census surges prevent us from doing so. We have worked to improve the quality of care we deliver and have endeavored to meet the needs of our patients and our families. It has been our goal that patients will verify that their stay with us has been “excellent.” During 2014, there was a focus on several specific areas of care and caring. • Respectful communication: - Having the more difficult conversations in a constructive manner. - Tools for direct conversations and confrontation. - Use of AIDET as an evidencedbased tool for meeting the patient’s need for information. • Order acknowledgement, confirmation, and implementation:
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to electronic orders required workflow changes that were difficult to understand until operational. New processes for confirming acknowledgement were developed. • Nurse-to-nurse bedside report and hand-off: - Thorough hand-off that involves the patient is the safest process for one caregiver handing a patient and the patient’s information over during a care transition. - I nformation exchange and practice verification may include patient identification; verification of infusions; assessment of wounds, dressings, and skin integrity; and explanation of individualized treatments. • Fall prevention: - The adoption of an evidencebased tool for fall risk assessment has increased nursing’s ability to identify patients at high risk for a fall. - I nterventions are put in place to help prevent a fall, including visual identifiers and alarm alerts.
- I n the ever changing would of informatics and electronic information systems, health care workers are challenged with information flow and documentation of care.
• Bowel function assessment, intervention, and consistent documentation:
- T he transition for written paper orders from physician
- Narcotics are commonly used for pain control in the acute
care setting and are correlated with constipation. Additionally, diet changes and decreased activity can make gastrointestinal function a critical area of focus for excellent patient outcomes. • Activities of daily living:
Looking Forward Goals set for 2015 will continue focusing on insuring competent clinical performance and striving for excellence in patient satisfaction while also increasing a sense of nursing professionalism and creating a healthy work environment.
- D aily hygiene is an important aspect of being human. Activity helps with healing and becoming stronger. We set an expectation for assistance of these functions in the morning and in the evening. - P hysical function deteriorates rapidly when a person is bedbound. Attention to ambulation routines has become a regular part of the patient’s day as able.
Vascular Access Team Patient conditions that require infusions caustic to human tissue require the placement of peripherally inserted central catheter. The three-person Vascular Access Team takes pride in performing PICC placement under careful, sterile technique using ultrasound for accuracy. Additionally, the team is available for difficult peripheral IV placement.
Bariatric Center of Excellence Mona Urwin, Bariatric Coordinator, and Diana Baratta, Director of Medical Surgical Services, collaborated in organizing to aide Regional West Medical Center in achieving national accreditation from the Center of Excellence in Metabolic and Bariatric Surgery through Surgical Review Corporation.
Regional West Health Services | 19
Birth and Infant Care Center and Pediatrics Birth and Infant Care Center (BICC)/Neonatal Intensive Care Unit (NICU)/Pediatrics
Staff: -W e welcomed some new faces and had some position changes in 2014 • BICC-Hannah Starksen, RN; Vivianna Palomo, RN; Adrian Brown, RN; Tiann Colwell filled the clinical coordinator position part time; Veronica Garza as unit secretary; and Liz Engel moved to a CRN position. • NICU- Ramona Vallejo, RN; and Brittany Seaney, RN.
Connie Rupp, BSN, RN | Director, Birth and Infant Care Center and Pediatrics
- EVS changes • W e have worked very hard with Mike Parker to improve the look of the unit. The last two months of the year showed that we have made great improvement with the cleanliness of the unit and the patient rooms. Scores were in the 99th percentile. We recognized two of the EVS staff (Linda and Andrea) as our wingmen. -P atient written discharge instructions
• Reinforced and monitored for compliance.
• U nit Practice Council decided that it might improve patient satisfaction scores related to dismissal to write on the patient white board on the day of discharge “Go over patient written dismissal instructions.” Use scripting when talking with patients, such as, “We want to make sure that you are ready to go home and that you understand your dismissal instructions. You will receive a written copy for referral.”
- Discharge follow up phone calls
Staff Satisfaction:
• Completed on every discharged patient. Compliments and areas for improvement are passed on in Friday Updates.
- Nurses Week
• PEDS-No new additions.
Patient Satisfaction: -P atient satisfaction competency • All staff completed patient satisfaction exemplars, which shared a story about how they provided excellent patient care. The stories were shared in our Friday Updates. - Bedside report
- Leadership rounding • Completed on every patient at least once during patient stay. - AIDET • Staff completed competencies and reinforced during rounding. 20 | Nursing Annual Report
Will continue reinforcement in 2015.
• W eek of daily/nightly planned activities. Breakfast served by Connie and Erika, ice cream sponsored by Nursing Leadership, catered lunch, cake celebration, and pizza party. - Christmas party • O rganized by staff, we had a good turnout at the
Christmas party and everyone had a good time. - Flooring - New uniforms
Awards: -S andra Schwartz received the LPN of the Year award for Regional West Medical Center.
Education: -R N/LPN Competency Days were attended by all staff - I ndependent breast milk double check • T he staff is continuing to refine this process in order to avoid breast milk mixups. • C ompetencies were completed in the spring. Additional breast milk double checks will be conducted in 2015. - CRN/Relief charge nurse leadership retreat • T his was an all-day education retreat which included leadership traits, how to deal with difficult situations, good communication, job responsibilities, dealing with HR situations, and patient satisfaction. We will be planning another one or two for 2015. -O ur NICU staff attended and received their certifications for the S.T.A.B.L.E program. -H yperbilirubinemia treatment guidelines • D r. Jones presented evidenced-based guidelines for treating hyperbilirubinemia.
- Patient abuse and neglect
-N ew cautery for C-Section room
• A ll staff were educated on what to do if there is reported • This new one has more abuse or neglect. optional settings and is what is used in the main - GBS education OR for consistency. The • Nurses now give the parents old one was probably 30 a pamphlet on GBS as well or more years old. as verbally educating them on the signs and symptoms - Spacelabs monitor: of GBS and what to do. • Updated in Peds and BICC. - Subcutaneous hydration • P eds staff was educated on this new procedure. This is used for patients who are dehydrated and unable to get IV access.
- We trialed some new couch/ beds in BICC for spouses and were approved to buy four in 2015. This will be a patient satisfier. - New uniforms in BICC/PEDS
• In the fall, we implemented new uniforms. We chose - Skin to skin contact after pink tops with pewter gray delivery: pants and jackets. They • C ontinued education and are embroidered with the tracking of skin to skin. This Birth & Infant Care Center is an important measure beand Pediatrics logo. cause of how it relates to our breastfeeding core measures. It gives mothers and babies a good start to breastfeeding and is a good patient satisfier.
Breastfeeding:
• E quipment/Supplies/Unit improvements: - New flooring • I n July 2014, BICC received new flooring throughout the hallways, nurses’ stations, and waiting room. This was a patient, staff, and doctor satisfier! -B ICC counters in the patient nourishment centers were replaced this year.
Regional West Health Services | 21
Clinical Rescue Team, House Supervisors, Dialysis, Language Access, ANSOS, and Wound Clinic 2014 Accomplishments
Language Access:
Clinical Rescue Team (Float Pool):
•T he Language Access Coordinator was hired in March 2014.
• Clinical Rescue Team staff floated to the following areas in 2014: 2E, 2W, 3rd, and 4th, ICU/PCU, Postpartum, Peds, Outpatient Surgery, Interventional Radiology, Recovery Room, Cardiac Rehab, Scottsbluff Surgery Center, Pediatrics, BICC, and ED.
Sarah Shannon, BSN, RN | Director of Nursing Support
•W e currently have 17 RNs and 7 CNAs in the float pool. This number is expected to grow exponentially in 2015.
House Supervisors: • House supervisors maintain the following certifications: BLS, PALS, ACLS, and TNCC and CPI.
Dialysis: • Monthly Quality Assurance and Facility Management meetings have been established between DaVita and Reginal West Medical Center. A DaVita representative attends Regional West’s Infection Control Committee meetings. • DaVita started providing Peritoneal Dialysis Services at Regional West Medical Center. • DaVita staff was trained in CPI. •D aVita staff participates in Regional West fire drills while in our facility. • Eye wash station installation completed in RCU dialysis. •D aVita staff completed 100 percent flu shot verification. 22 | Nursing Annual Report
•L imited English Proficient (LEP) policies were developed. •V ideo Remote Interpretation (VRI) became available for accessing American Sign Language interpreters. VRI carts are accessible by contacting the Language Access Coordinator or house supervisor. • I nterpreter services have been provided in but not limited to the following areas: Neurology, Family Practice, Pain Clinic, Pre-admit/perinatal, Inpatient and Outpatient Rehab, Pediatrics, Orthopaedics, Psychiatry, Scottsbluff Surgery Center/ Outpatient Surgery, Imaging Services, ENT, Urology, Plastic Surgery, Birth and Infant Care Center, Diabetes Care Center, Regional West nursing units, social workers, and billing. • Translation of vital documents is progressing. •T otal encounters from March 1, 2014 through January 31, 2015. We average 60 interactions a month with these numbers increasing. The average interpretation takes 20 to 30 minutes per session.
ANSOS: •T he ANSOS upgrade was approved in the last quarter of 2014. More to come on this.
Wound Care/Ostomy Skin Integrity Team Committee and Pressure Ulcer Prevalent Studies
Magnet Quarterly Prevalence Pressure Ulcer Study results for 2014
Skin Integrity Team Committee meets the second Tuesday of each month at noon in the Goshen room.
February 24, 2014, also participated in Hill-Rom National Study
Goal: To educate staff on interventions and prevention of skin related issues. The following units are represented: PCU, ICU, 2W, 2E, 3rd, 4th, Dietary, Education, Interventional Radiology, Purchasing, and Wound and Ostomy Care.
•1 5 skin team members participated • Assessed 65 out of 75 patients •2 patients with pressure ulcers (PUs) • 0 Hospital Acquired (HA) • 2 Present on Admission (POA)
April 22, 2014
The Skin Integrity Team members are active participants in the Quarterly Pressure Ulcer Prevalence Studies and the Annual International Hill-Rom Pressure Ulcer Prevalence Study.
•1 1 skin team members participated
Hill-Rom provided training on specialty beds and surfaces used at Regional West Medical Center. Jane Gachne (ARU), John Seiler (3rd), Catherine Strauss (2E), Diana Shaw (2W), and Rebecca Hubbard (ICU/PCU) completed the Hill-Rom bed super user training. Bed training was presented to staff at our 2014 Nurse Competency Days.
•5 POA
Team members also authored a week of dailies for the week of Oct. 27th on “SKIN” (S-skin surfaces, K-keep turning, I- incident reporting (documentation and referrals), N-nutrition). Due to increase in volumes, Wound Clinic staff now sees new patients on Tuesdays.
•A ssessed 69 out of 76 patients •5 patients with Pus •0 HA
Jeanette McFeely, RN, BSN, CWOCN | Chair, Skin Integrity Team Committee
July 22, 2014 •9 skin team members participated • Assessed 54 out of 61 patients • 1 patient with PU • 0 HA • 1 POA
October 28, 2014 •1 2 skin team members participated •A ssessed 64 out of 72 patients •2 patients with Pus •2 HA •0 POA
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Perioperative Services Janet Lewis retired in 2014.
Janet Lewis, MA, BSN, RN, CNOR | Director, Perioperative Services
Operating Room (OR) The hospital’s Operating Room is dedicated to providing surgical care to members of our community and outlying regions. Staff provides coverage 24 hours a day for Regional West Medical Center’s Level II Trauma Center.
2014 Highlights Education and patient safety remains a priority for the Operating Room. Our safety coach, Marcene Wiegand, BSN, RN, has presented the Safety Bundles throughout the year. Staff has been engaged in the learning opportunities that were presented by Marcene. Safety issues or concerns are discussed at our 6:30 a.m. daily huddle.
Kim Brown, BSN, RN, CNOR | Unit Manager, Operating Room
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Staff’s need for education continues to grow and our Clinical Educator, Rhonda Groshans, provides many hours of ongoing education and competency testing at Monday morning education sessions. Annual education provided for 2014 included: programs on laser safety, AIDET, retained surgical items, review of surgical instruments, pathways for bariatric excellence,
urology bipolar equipment, emergency tracheostomy, sharps safety, review of the abuse/neglect policy, monitoring local anesthesia, surgical fires, shoulder positioner, hands on training for use of 2-way radios, review of bronchoscope (adult and pediatric), fibrin sealant sprayer for laparoscopic use, eye trauma, and a video viewed from the University of Nebraska demonstrating proper technique for donning and doffing barrier attire to protect staff against Ebola. Four simulations involving “Fire in the OR” were completed. These scenarios were a great success and proved to be a very important learning tool for the Operating Room staff. A formal debriefing was held to discuss the opportunities for improvement. Additionally, evacuation plans for the OR
and PACU were developed. These protocols are now a part of unit orientation. The Stanford Emergency Manuals located in all of the operating rooms, PACU, and the SSC have been updated with the latest information distributed by Stanford. The manual contains several critical events as well as Crisis Resource Management key points to help clinicians deliver the best possible care during medical emergencies. It is an excellent tool to use in simulation exercises. A bariatric resource manual has also been created for the Operating Room. The manual includes bed weight limits, positioning devices, transfer devices, location of the difficult airway cart, and troubleshooting suggestions. New Perioperative assistants are Heather Schlager and Jen Upton. Nurses hired in 2014 include: Jesse Newberry, BSN, RN; Katie Kenehan, RN; Shereen English, BSN, RN; Jen Chasek, ADN, RN; and Aubrey Tousignant, BSN, RN. Brooke McMackin, CST was hired as a surgical tech and successfully passed her certification exam to become a Certified Surgical Tech. Periop 101 graduates for 2014 are Marcene Wiegand, BSN, RN, and Jesse Newberry, BSN, RN. Nate Walker, RN, RCIS, CNOR passed his certification for the Operating Room, which increased the number of certified nurses to 10.
All nursing staff completed the hospital competency days with positive feedback for the experience. Clinical Educator Rhonda Groshan, RN has been busy providing orientation to the WNCC nursing class prior to their experience in the Operating Room. She also promoted perioperative nursing at Regional West Medical Center by attending the University of Wyoming career days, and traveling to Creighton University for a job fair. Recruitment is a major priority for the Operating Room. Anesthesiologists Dr. Abel Luksan and Dr. Brent Ellison were nominated by several staff members in the Operating Room to be our “wingmen.� Staff expressed that Dr. Luksan and Dr. Ellison put patient safety first and always watch out for staff in difficult situations.
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Outpatient Surgery (OPS) and Perianesthesia Care Unit (PACU) The theme from the national organization, American Society of Perianesthesia Nurses (ASPAN), for 2014 was “Perianesthesia Nurses Caring Every Step of the Way.” This theme really did set the tone for OPS and PACU this year as they set out to improve patient satisfaction scores by providing excellent patient care and addressing the patient’s needs on an individualized level. Recognizing that patients and families need to be kept informed about delays in procedures/surgery, the staff has concentrated on hourly rounding and frequent phone calls. We did see success with this focus with improvement in the Health Streams Patient Satisfaction scores. We will continue these efforts for patient satisfaction. Continuous education and reinforcement of the use of safety tools by our safety coaches has been instrumental in providing a safe environment for patients and staff as we strive for “zero events of harm.”
Karna Kleager, BS, RN | Unit Manager Outpatient Surgery | Perianesthesia Care Unit
The focus of OPS continues to be the daily admission of patients for surgical procedures with approximately two thirds of the admissions returning from surgery to be discharged the same day. The patients requiring outpatient infusion/transfusion therapy remains steady. PACU nurses focus on providing a critical level of care to patients during the pre-op phase and postoperatively as patients emerge from anesthesia as well as the surgical procedure. Challenges include caring for patients of all ages following surgical cases that vary in complexity. Both PACU and OPS have been successful with creative staffing to maintain adequate staffing levels from 5:30 a.m. when patients first arrive till after 11 p.m. when patients are being discharged after surgery.
Performance Improvement Activities • Hand hygiene monitoring • AIDET observations
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•C ompletion of Point of Care chart audits • First Case On-time Start survey
Professional Status Activities •K ay Lemons, Andrea Ray, Sandy Hebbert, Chris Micheels, Tracy Payne, Roxie Shaul, and Michelle Keener maintain certifications in Perianesthesia Nursing. •M ichelle Powell is certified in Medical Surgical Nursing. •T racy Payne was selected to serve on the American Board of Perianesthesia Nursing Certification, Inc. This group of dedicated professionals is responsible for item writing (examination questions) for the national Certified Perianesthesia Nursing Examination. Tracy traveled to Nashville, Tenn. in late October where she joined ASPAN colleagues for a week of intense work. Tracy has a passion for education, both learning and teaching. This
was quite an honor for Tracy and we’re proud to have her representing her profession and western Nebraska.
Committee/Council Representation •L aura Wright: Simulation coordinator, PACU staffing/scheduling •G inny Blackburn: Peer Review, Bariatric, PACU UPC •H ope Hanson: Handoff communication task force • Sandy Hebbert: PACU UPC •K ay Lemons: Shared Governance Professional Practice, PAUC UPC •C hris Micheels: DEU CSI, safety coach •T racy Payne: DEU CSI, PACU Service Excellence Team •A ndrea Ray: PACU staffing/ scheduling, PACU UPC, fit mask testing •N ancy Ross: ER 12 super user, Paragon super user •K atherine Tuttle: PACU UPC chair, Shared Governance Quality/Safety, ER 12 super user, Crash cart/CODE BLUE annual review •K ellie Witcofski: Shared Governance Care & Practice, Hand hygiene monitor, Fit mask testing, PACU Service Excellence •M arlyce Burkey: Nurse/Pharmacy Committee, Crash cart/ CODE BLUE annual review • Aggie Collopy: OPS UPC •B obbi Decker: OPS UPC, Concurrent record review coordination
•M ary Duncan: OPS staffing/ scheduling, Shared Governance Professional Practice, OPS UPC •K elsey Judy: Shared Governance Care and Practice •M ichelle Keener: Informatics, ER 12 super users, Concurrent record review coordination •J ennifer Meyer: OPS staffing / scheduling •S hon Peterson: OPS Service Excellence Team •A licia Snelling: OPS Service Excellence Team, Hand hygiene monitor •M ichelle Powell: Shared Governance Quality and Safety, Shared Governance Coordinating Council, Safety behavior trainer, Safety coach •R oxie Shaul: Shared Governance, Nurse Finance Council •K endra Vera: OPS UPC chair, Safety coach
New Faces to our Units •O PS: Allison Furby, RN, graduated UNMC May 2014 •P ACU: Hope Hansen, RN, graduated UNMC May 2014 •B ette Griffiths, RN, transfer from 2W •S amantha Kizzire, RN, transfer from 2W With Paragon on the horizon, both OPS and PACU are looking forward to 2015 and being able to continue to be those nurses who care every step of the way.
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Scottsbluff Surgery Center (SBSC) The Surgery Center continues to keep busy with the comings and goings of new medical staff as well as students from various local schools. Our volume stayed busy although we had a small dip from last year, ringing in the end of the year treating over 1,386 patients. We are so humbled to be able to be a part of one’s surgical experience within the community. Some of the events that occurred throughout the year have included a huge emphasis on the UPC Committee and the work that they have accomplished within our unit. We implemented a patient pamphlet used in the clinic when scheduling patients at the Surgery Center that explains what to expect before their procedure, the day of their procedure, and after their procedure. We have found this very helpful when prepping patients for their surgeries.
Crystal Kildow, BSN, RN | Clinical Coordinator, Scottsbluff Surgery Center
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Another project has been to focus on some marketing. Many individuals and organizations around the community were not aware that there was a Surgery Center located right here in the panhandle. So the UPC committee worked with our Marketing Department to get added to the Regional West Health Services website, featuring pictures and information about the services that we provide. We were also recently featured in the Healthy Times. A picture of both the Surgery Center and Endoscopy staff was taken to introduce us to the community. The UPC committee also featured a six-week refresher session on AIDET and the importance of incorporating this into our daily routine. This has been so valuable for the staff and management for really focusing on our patient satisfaction scores. We are excited to keep up the good work and provide satisfying quality of care to the community.
Another process we implemented was mailing thank you cards to our patients. We just wanted to send a little note letting patients know that we are thankful to be part of their surgical experience. Electronic Physician Writer (EPW) was also implemented this year as a way to allow physicians to print prescriptions for patients or send them electronically to the pharmacy. This is a fabulous way for providers to utilize the technology meant for efficient care. In dealing with so many pediatric patients, we were able to help facilitate the implementation of Kyra’s Kisses. This program offers toys in a tote in honor of Kyra, a two-year old diagnosed in 2013 with Diffuse Intrinsic Pontine Glioma (DIPG), which eventually took her life. This organization is dedicated to raising funds to supply toys to the hospital for scared, sick, or hurt children. We are able to give out toys to the many children who are seen here for their surgical procedures. The staff here at the Surgery Center is hoping for a busy and prosperous 2015. Our focus will be on AIDET and improving the outpatient surgical experience as well as a successful implementation of the new Paragon system. We are proud to be part of Regional West Health Services and look forward to what 2015 will bring.
Endoscopy & Pre-Admit Testing (PAT) Endoscopy
Pre-Admit Testing
Endoscopy nurses provide the majority of their nursing care to patients at the Scottsbluff Surgery Center-Endoscopy Unit. However, they also provide support to the inpatients at Regional West Medical Center who need an endoscopic procedure. Thus they also strive to be knowledgeable of the hospital nursing protocols by being involved with PCS’s nursing activities.
Pre-Admit Testing (PAT) staff saw over 6,200 patients in 2014. This number includes those we saw in advance of the day of surgery and those whose preliminary visit had been via telephone, with the completion of the visit on the day they came in for their procedure.
The nursing staff helped promote the health of the community for colon cancer awareness by setting up the 2nd Annual Boxer Rebellion, which was a 5K run run/walk that raised awareness for colon cancer month. They raised over $800 that they donated to the Festival of Hope. We also continue using the EMMI program for all of our colonoscopy patients. On the Top 5 Prescribed Programs for Regional West Medical Center, the number one spot went to Colonoscopy. A big shout out to the Patient Access Team for doing their part to make this program successful. Promoting continuing education is an ongoing goal of the nurses which was evident by: •L ucrecia Spady, Amber Gomez, and Rebecca Robles represent Endoscopy on the Shared Governance Councils. •J oni Bruce is our safety coach and will help us stay educated on our safety culture initiatives.
We continue to use Expectation Management of Medical Information, or EMMI for short, an online education tool that is assigned by the surgeon’s office staff. Patients can access educational material concerning their operative procedure and ask questions about their procedure. Pre-Admit Testing staff then does a follow up with the patient to see if they watched EMMI and if they have any questions that EMMI did not answer. We are finding that the patients who watch EMMI really like the program and most feel that EMMI answered any questions they had.
Lucrecia Spady, MSN, RN, CGRN | Unit Manager, Endoscopy & Pre-Admit Testing
Work began on the process for patients having surgery at the Scottsbluff Surgery Center (SBSC). If the SBSC staff feels that the patient needs to be seen by the PAT staff, they will send them through the PAT department for a thorough anesthesia evaluation. Another new process that was started was the PAT staff now alerts the floor staff when PAT nurses see an unexpected high fall risk patient.
•L ucrecia Spady, unit manager, continues to be the management advisor for the Quality and Safety Council. Regional West Health Services | 29
Critical Care and Emergency We strive every day, with every patient, to deliver high quality safe patient care while utilizing our resources efficiently. Our staffs have embraced bettering themselves and our product, “excellent patient care” this year. A few of our accomplishments are stated below.
Awards
Evidence-Based Practice
•S tarted the Beacon Award journey and will apply for the award in April 2015 after 12 months of quality data supporting our narrative of accomplishments and patient outcomes.
•R einforced and continued to work on improving and preventing Ventilator Associated Events (VAE). The criteria have become more stringent this year.
•B rooke Dollarhyde was awarded the structural empowerment leadership of Unit Practice Council co-leading the sepsis education and practice changes.
Nancy Hicks-Arsenault, MBA, BSN, RN | Director, Critical Care and Emergency Services
•G illian Blaha was awarded the new knowledge and innovation award for starting the healthy work environment team and her preceptor work. •J osh Beals was awarded the transformational leadership award for his activities with his night shift staff and new graduates.
Quality and Core Measures • AIDET training to improve patient satisfaction. • Restraint policy and procedure was updated and resulted in reduction of restraint use. • Updated and improved stroke documentation of data retrieval of core measure data. • Continued to work on CLABSI process to prevent blood stream infections CAUTI protocol, procedures, and orders enhanced and resulted in decreasing days patients have catheters indwelling.
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•A BCDE bundle use is part of the VAE initiatives. ABC includes daily awakening and spontaneous breathing trials coordinated and selective choice of sedatives, D is for completing a delirium assessment and implementing appropriate interventions, and E is for early mobility. Yes, we do ambulate our patients while on the ventilator if possible. •C POT, a critical care observation tool was implemented to improve pain scoring for the sedated patient. •R eviewed the 2014 sepsis guidelines, compared to our current and adjusted orders sets as needed after collaboration with our providers. • I RB approved a research project started to prevent post-traumatic stress disorder and delirium. • I nstituted the use of chlorhexidine baths as an approach for bacterial decolonization resulting in decrease in infections and changed the bacteria found to more common bacteria, which are easier to treat.
Medication Administration •T he titration screens were corrected to allow nursing to titrate medication infusions more readily. •E ducation and competency was done for sub Q hydration for appropriate patients.
•W orking on improving the patient satisfaction question: Nursing did everything they could for my pain.
Education •F acilitated unit and hospitalwide competency days.
•U pdated and revised the IV pump libraries with improved compliance in use of pump libraries and fewer alerts.
•E KG class for CNAs in the CICU/PCU to become telemetry technicians.
Unit Practice Council and Healthy Work Environment Group
•P oster education on decision tree for cardiac testing.
•C ritical care transition course.
Critical Care Services Staff New RNs on our team include: Tara Harris Jack Arnold Ruth Cochran Joanne Herron Megan Krein Joshlyn Mosher Andrea Banks
•R evised and updated the rounding plan of care/hand off sheet. Continue to work to improve hand off communication efficiency while improving accuracy.
Brittany King
•W orking on development of a bowel care program.
Jennifer Hyde
•W orking on implementation of the healthy work environment according to ACCN.
Danielle Moore
Anna Walters
New CNAs with telemetry training joining our team include: Juan Rejino
Regional West Health Services | 31
Critical Care and Emergency (cont.)
Emergency services Staff New RNs Nicole Shrob Pam Englehaupt Stephanie Burns Cheryl Koob Vanessa Nelson Tori Towne Angie Gollas Brooke Borgman
New CNAs Ashley Harimon Ashley Hill Kayla Roberts
New unit secretaries Morgan Blomstedt Sharon Ruff
Quality and Core Measures
Medication Administration
• AIDET training to improve patient satisfaction.
•T he titration screens were corrected to allow nursing to titrate medication infusions more readily.
• Restraint policy and procedure was updated and resulted in reduction of restraint use and improved documentation. • Updated and improved stroke documentation of data retrieval of core measure data. • Implemented direct bedding to expedite patients to a treatment area and shaved off an average of 17 minutes from door to treatment bed per patient. • I mplemented direct call to the receiving charge nurse for admitted patients eliminating an average of 20 minutes in the bed assignment process. •S ustained documentation of stop times improving billing for infusions by $617,000 this year. • I mproved arrangement of trauma room supplies. • I mproved our door to EKG times by revising the protocol.
Evidence-Based Practice • Reviewed the 2014 sepsis guidelines, compared to our current and adjusted orders sets as needed after collaboration with our providers. • I mplemented sub Q hydration practice after education and competency. •W orked on improving our safety measures after collaboration with security and administration.
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•E ducation and competency was done for sub Q hydration for appropriate patients. •U pdated and revised the IV pump libraries with improved compliance in use of pump libraries and fewer alerts.
Unit Practice Council •W orked on making visual reminders for staff to document our core measure interventions improving our door to antibiotic time for pneumonia patients. •C reated “bone” ques to remind staff to treat and document long bone pain immediately. •R elocated supplies in the trauma bays after working with trauma team and re-labelling of supply cabinets to read across the room.
Education •F acilitated unit and hospital wide competency days. • Critical care transition course. • Ebola training. • Active shooter exercise. • Pediatric case reviews. •P rocedural sedation procedure, documentation, and cases were reviewed.
Awards •B ecky Avila was awarded the nurse preceptor award for her professionalism with students and encouraging their learning experiences. •M elissa Amateis Leibnitz was awarded the empirical outcomes award for her creativity in visual reminders helping all staffs reach our quality outcome measurers.
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Air Link and Transfer Center Doug Carrell | Director, Air Link and Transfer Center
Air Link Air Link continues to provide service in partnership with MedTrans Corporation. Air Link welcomed a new pilot, Joe Sherman, to our team. We are also proud to announce the arrival of a new helicopter. The new helicopter has state-of-the-art safety equipment installed. The helicopter was put into service December 10, 2014. An open house was held on December 9 to view the new helicopter and visit with present and past crew members. The Air Link management team consists of Doug Carrell, Director; Tracy Meyer, Chief Flight Nurse; and Dr. Peter Meyer, Medical Director. Dr. Meyer continues to fly as an active crew member of the flight team. 34 | Nursing Annual Report
Sean Shirley is Air Link’s safety officer and safety coach. Sean is also involved in our PAIP (Post Accident Incident Plan) drill planning. Sean was deployed to Germany to serve for the military until mid-June 2014. Trish Garner is very active as the clinical educator of the flight team, and has been instrumental in coordinating on going educational events. Wade Wells compiles quality improvement data. Natalie Arnold coordinates public relations events and the Air Link mentoring program (which includes over 80 hospital and EMS agencies). Jason Rairigh and Howard McCormick continue to coordinate the equipment and inventory needs of the program. Dee Vogel assists with policy review and time and attendance. Dee is Air Link’s
representative for the Nebraska Association of Air Medical Services (NEAAMS). We welcomed a new flight paramedic to our program, Bridget McCormick. Kyla Ansley continues to assist the flight team with marketing and public relations. Every member of the Air Link flight team has additional responsibilities that directly relate to the quality of the service we provide. In April 2014, Tracy Meyer and Doug Carrell attended MTLI (Medical Transport Leadership Institute). This is a two-year program that is 100 percent related to the management of air medical programs. Tracy and Doug will be attending year two in April 2015 and will both graduate with a Medical Transport Executive (CMTE) certification. The Air Medical Transport Conference (AMTC) was held in Nashville, Tenn. in September 2014. We held our annual Air Link EMS conference. Air Link places an emphasis on quality patient care, continued learning, and mandatory advanced certifications. The members of the Air Link flight team are CFRN (Certified Flight Registered Nurse) or FP-C (Flight Paramedic Certified) certified, with the exception of the newly hired members, who are studying to take their exams. Air Link had a very busy year, and looks forward to having another successful and SAFE 2015.
Transfer Center The Transfer Center management team is: Doug Carrell, director; Peter Meyer, MD, medical director; and Brandon Subjeck, supervisor. The Transfer Center is very busy with many different tasks
to handle on a daily basis. Transfer Center duties include: facilitating/coordinating patient transfers both to and from Regional West Medical Center as well as assisting other hospitals with patient transfers not coming to or transferring from Regional West Medical Center; dispatching and flight following Air Link-Scottsbluff, Air Link-Loveland, Colo., and Eagle Med 31 (fixed wing) located at the Scottsbluff airport; staffing the switch board 24/7/365; handling after hours IT answering services; announcing all overhead pages and codes; and monitoring all alarms, just to name a few of the tasks. The staff also monitors emergent events, not only locally, but also outside of the local area. By monitoring these events, in the case that additional resources are needed to handle the event, if requested to assist, the Transfer Center will be able address those needs in a timely manner. Typical events that are monitored include: weather emergencies, emergent ambulance, and law enforcement radio traffic. The Transfer Center is staffed 24/7 with three staff from 0800 to 2000 and two staff from 2000 to 0800. Brandon Subjeck has taken over the Transfer Center supervisor. Ongoing education and training continued to take place throughout the year. With Brandon’s guidance and the participation of a very dedicated staff, the Transfer Center had a very busy 2014. The staff handled over 1,651 Transfer Center Calls, completed 1,297 direct admits, and also received 1,719 flight requests. We look forward to having another successful 2015.
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Home Care & Hospice 2014 was the year of positive forward motion involving Home Care, Hospice, and Palliative Care. 2014 finds all three entities under one roof‌ the Regional West Medical Center roof! Prairie Haven Hospice moved from a separate corporation under Regional West Health Services and came under Regional West Medical Center May 1, 2014. Since that time, the Hospice staff, under the direction of Diana Rohrick, has seen several changes, not the least of which is the preparation for Joint Commission Accreditation. Regional West policies have been implemented. A new safety coach, Ronna Leider, has been trained and is actively working with the Hospice staff to bring them into the Culture of Safety.
Diana Rohrick, RN | Director, Home Care, Palliative Care, Hospice (formerly Prairie Haven Hospice)
Suzy Solano, clinical team leader for Hospice, has joined the Infection Control Committee and has worked with Amanda Sabo on infection control issues and with Margo Ferguson regarding data collection and analysis. Hospice staff is now entering patient falls into Midas. Jackie Robison has helped immeasurably with preparation for the Joint Commission Accreditation of Prairie Haven Hospice, along with the various chapter leaders from Regional West Medical Center.
inquire about any issues that our providers may have with Hospice as referrals and census were down significantly. Once these findings are reviewed, community focus groups and community education will take place to let the residents of our area know what is available in the continuum of care at Regional West Medical Center. The main theme will be the collaboration between Home Care, Palliative Care, and Hospice and how these entities work together and separately.
As always, with a focus on exceptional patient care, both Hospice and Home Care have been dealing with regulatory changes and the challenges they pose. Where Home Care is fairly used to the regularity of CMS decisions, Hospice is not. The whole Hospice realm has not ever seen significant regulatory changes like this! But true to their passion for their calling, they are working through it and with each change and continuing to provide care that shows how much they care.
Palliative Care has seen not only growth in the program but a better understanding by staff and providers of what Palliative Care means and what it can bring to Regional West. While working with staff and physicians in all areas, an enhanced understanding of not only end of life care but symptom management and pain control for chronic diseases has been forthcoming. Connie Beehler, MD and Deb Moore, APRN, have also shared their knowledge and expertise with the Home Care and Hospice teams.
We have been working with the Marketing team to enhance referrals to all three entities. A survey was initially sent out to Regional West physicians to 36 | Nursing Annual Report
Home Care has seen a welcome increase in referrals. Doing this while taking on a major new documentation project that has put their super users to the test,
has shown them to be both competent and able to conquer this with the assistance of Linda Ferreyra and Deb Keller, both from IS. The Partnership Unit Practice Council has been active since its inception in 2013. Diann Lauder, Chair, and Kathy McLellan, Vice Chair, keep the group focused on issues pertinent to both departments. The group is working on joint mission/vision statements, self-marketing, communication improvement, and forms to enhance transfers between Home Care and Hospice. Diann is retiring in November and will be sorely missed. Her passion for Hospice is evident in everything she does. Kathy will then take over as chair for one more year, as determined by the group. Chris Centgraf Baker, Home Care clinical team leader, will be leaving us shortly. Chris recently married Bill Baker, a vet from the Hyannis area and plans to make her home in that area. Though the team will miss her greatly, Chris has established a great foundation on which to grow. And grow we will! As these three teams continue to grow, collaborate, and educate, don’t be surprised if you find yourself understanding them better and agreeing that they are a much-needed part of our vast care team at Regional West Medical Center.
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Imaging Services In 2014, Imaging Services nurses have seen a total of 2,861 patients, an increase of 12 percent over 2013. We also continue to do follow-up rounds on our inpatients and follow-up phone calls on our invasive procedure patients who went home. In the Angio Suite, 111 angio/ venograms, 11 arterial declots, 72 central lines, 91 dialysis fistulas, four tumor embolizations, 12 endografts, 40 IVC filters, 90 kyphoplastys, and two miscellaneous for a total of 433.
Kari Flom, RN | Radiology Supervisor, Imaging Services
In CT, we saw 141 sedated biopsies, 129 drains, and 179 hydrations for a total of 449. In our main department, there were 719 pain management, 192 myelograms and LPs, and 110 miscellaneous for a total of 1,022. MRI saw 116 patients and NM had 52. US saw 121 biopsies and 119 centesis for a total of 240. Our hospital-based clinic has also grown, with 430 patients seen only in the clinic and prep and recovery areas. We have utilized the clinic to better prepare our patients for their procedures, identify potential
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issues in advance, and do followup visits when necessary. Of these patients, 507 were added on, 330 were inpatients, 44 received stents, and 39 were with anesthesia. Imaging Services nurses continue to be involved in our IR Council as well as chairing the Shared Governance Committees. We are active in our professional organizations, and together strive to be strong patient advocates, providing the safest care possible. We also have a commitment to lifelong learning, with one person applying to get in to a master’s program and one who finished the master’s program and has applied for the post-master’s program.
Cardiac Cath Lab 2014 opened the door for new excitement in the Cardiac Catherization Lab. John Vidlak, Dr. Lambert, and Mike Smith began the search for new Cath Lab equipment. This includes new X-ray equipment and a monitoring system. The staff was able to meet with vendors in Colorado in December. We are excited about the technological steps we are going to take with the new lab. We are anticipating tremendous growth in productivity and quality of patient care. Our staff has gone through some growing changes and Jenna Sims, RN has joined our team this year. We look forward to adding Diana Flores, RN to our staff in 2015! Facilities Management has installed televisions in our procedure rooms to improve patient satisfaction and comfort. The nursing staff is now able to aid the echocardiogram sonographers with the use of Definity contrast to obtain better images during echocardiograms. The nurses were trained and worked closely with Ward Krichau to be able to make this available for patient use. We have had great results!
Michelle Rairigh and Jenna Sims prepared an in-service for outpatient surgery on the use of the TR bands for radial approach heart catherizations. This led to Michelle updating heart catherization order sheets and dismissal sheets that improved communication between the Cath Lab and Outpatient Surgery. We look forward to the changes 2015 will bring to the Cardiac Catherization Lab!
Jenna Sims, RN | Cardiac Cath Lab
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Cardiac and Pulmonary Rehabilitation This year started off quite busy with the national re-certification process of the cardiac program, which takes place every three years and requires extensive tracking and compiling of patient data. However, once everything is completed and submitted, the waiting began. After waiting a very long eight months, we finally received notification that our cardiac program passed the rigorous National American Association of Cardiovascular and Pulmonary Rehabilitation re-certification process.
Nancy Leisy RN, MSHS, CHES | Cardiac and Pulmonary Rehabilitation Manager
The entire cardiac rehab team was actively involved in the Go Red for Women and Heart Disease promotion in February. There was a media blitz of information and education, and staff also volunteered their knowledge at the Girls Day Out promotion, as well as continuing their community efforts later in the year by providing heart healthy information at the Summit to Summit Challenge. Education coordinator Kara Lemoine, RN, BSN hit the ground running this year with several education modules to motivate patients toward healthy lifestyle changes including: 100 Days of Real Food, a 14-week program; The Benefits of Exercise, a 12-week program; and Diabetes Prevention, a 14-week program. Our patients, as well as maintenance participants, had the availability to learn something each week with these new educational opportunities. Patti Edwards, LPN has taken the lead as the maintenance program team leader. She created and implemented a new incentive program designed to acknowledge the hard work of positive healthy behaviors among the maintenance program participants.
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This has been a fun program and well received among the maintenance group. Pam Zitterkopf, RN, BSN, and Nancy Leisy, RN, MSHS, CHES attended the national AACVPR conference this year in Denver and learned many new and exciting ways to make exercise and education more fun and challenging for patients. Staff also received new education on helping implement the newly covered diagnosis of congestive heart failure into the Cardiac Rehab program. This will be a great benefit for the patients in our service area who need rehabilitative services and we look forward to serving them in our program.
Case Management Lois Cannell | Case Manager | Case Management & Clinical Documentation Improvement (CDI) Nurses
Case Management 2014 has been a busy year for Case Management. The department continues to monitor new rules and regulations by the Centers for Medicare and Medicaid Services (CMS). The RN case managers offer support to the patient care providers on changes that CMS is currently making as well as proposed in the near future. The Case Management Team includes: Julie Kautz, RN; Irma Walter, RN; Jessica Brumbaugh, RN; Nichole Hoesing, RN; Vicki McLamb, RN; Lois Cannell, RN; Karen Houk, RN, CM Supervisor; and Jodi Willats, MSW and Stephanie Hawley, RN, Interim Co-Directors. Case Management physician advisors are Dr. Lindsey Mosel, Dr. Adeel Bashir, and Dr. Jason Walsh. The case managers perform daily clinical chart reviews utilizing Interqual Level of Care Criteria, which is updated annually. If cases do not meet criteria by this method, then the case manager performs the review with Executive Health Resources (EHR) or the physician advisors within our facility. Reviews are also completed with insurance companies to pre-certify admissions as well as outpatient infusions of patients with private insurance. The RN case managers complete well over 2,000 concurrent review entries every month. RN case managers work closely with social workers and the interdisciplinary team to move patients through the continuum of care. In addition to these duties, the case managers also communicate with patients and their families about
insurance information, Medicare letters, and observation status.
Clinical Documentation Improvement (CDI) Nurses It’s been another demanding year for the Clinical Documentation Improvement (CDI) nurses. While they carry on reviewing charts daily and educate providers to improve the quality of the documentation in the record, they also continue to keep focused on ICD-10 education. There are many changes that will be necessary in order to accurately capture the acuity of our patients and the hard work of our providers. Some of the verbiage required to capture this has changed and while it may all mean the same thing in the medical world, it does not translate that easily into the billing world where our facility and physicians are being graded. This verbiage is also required to be in the record in order for Regional West Medical Center to be reimbursed appropriately. The CDI RN case managers have undergone intensive on-line training courses (totaling over 100 hours each) as well as attending an off-site ICD-10 for CDI Boot Camp. Most recently they attended an in-house program that was geared towards the providers and the documentation that will be required once ICD-10 is officially implemented. ICD-10 implementation was supposed to be implemented on October 1, 2014 but has since been delayed to October 1, 2015. In order to be fully prepared, the CDI RN case managers have already started
Pictured L to R: Alane Britt, Julie Kautz, Lois Cannell, Karen Houk, Shannon Brown, Nichole Hoesing, Irma Walter
making changes to the provider query forms in order to familiarize the providers with the upcoming changes and necessary documentation. The current CDI RN case managers are: Andrea Arellano, RN, who covers the general medical service lines; Jackie Carter, RN, who covers the surgical service lines; and Mollie Thompson, RN, who covers the hospitalist service line. Stephanie Hawley, RN, ACM directly oversees the CDI program for the facility.
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Community Health The Community Health Department at Regional West Medical Center continues to play an active role in the health of our community. A creative contract with Scotts Bluff County Health Department allows Community Health to provide the public nursing hours for the county and provide community outreach for the hospital. This past year, multiple programs were coordinated for the community and hospital.
Paulette Schnell, RN | Nurse Manager
The staff is made up of five part-time RNs, a part-time office position, and the nurse manager. The department is also fortunate to have active volunteers who assist us in our programs. Education continues to be an important part of maintaining a strong knowledge base within our nursing staff to provide the best service possible for the community. Immunization state programs, emergency planning, epidemiology updates, wellness promotion, and colon cancer screening outreach were all trainings that staff attended this year. Community Health nurse Hannah Weisgerber and Nurse Manager Paulette Schnell will graduate with their master’s degrees in nursing from UNMC in spring 2015. Community Health provides the epidemiology and investigation of reportable diseases for Scotts Bluff County. This year pertussis and West Nile were at the top of the list in the number of cases. Ebola hit the headlines in the news and was a topic that Community Health coordinated, including prevention education and planning for the possibility with health care providers and the hospital. The Community Health Immunization Clinic continues to provide immunizations for both the Vaccine for Children’s Program and for privately insured clients of all ages. We provide all travel vaccines as well. Nurses hold routine
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immunization clinics on Tuesdays with both daytime and evening clinics available. Approximately 3,500 vaccines are annually delivered to children from birth through age 19. The department has also been working closely with ABM, UNMC, and WNCC to provide record reviews for employees and students who will be working or training within Regional West Medical Center. Colon cancer awareness and a screening kit distribution campaign took place with information being shared on risk factors. Deb Keener, RN, is the project coordinator. Our department was recognized by the Nebraska State Health Department for being the organization with the highest return rate for fecal occult blood test (FOBT) kits in the state. Community Health also participated in a research study with the University Of Nebraska College Of Public Health that looked at barriers to colon cancer screening in rural and urban areas in Nebraska. Results should be available in the spring of 2015. Community Health is an active partner in the Panhandle Regional Medical Response System (PRMRS), attending monthly meetings and assisting with the coordination of both the county and hospital’s bio-terrorism and all-emergency preparedness plans. Community Health participated in the coordination
and implementation of a community-wide radiation exposure full scale exercise in September. Throughout the year, Community Health also coordinated quarterly genetics clinics with Munroe-Meyer Institute, a part of the University of Nebraska at Omaha. There is no charge for the consultation with this team of experts. Over 80 clients and their families were served in 2014. In 2014, Community Health worked with an area group made up of hospitals and health departments to conduct a Community Health needs assessment. Our activities were focused on Scotts Bluff County and involved gathering data and conducting focus groups. The results will be utilized to create a Community Health improvement plan for Regional West Medical Center and Scotts Bluff County in 2015. Terri Allen, coordinator of the Scotts Bluff County Worksite Wellness Coalition, coordinated several health screenings at area businesses. The department also worked with the Panhandle Worksite Wellness Council to promote wellness at the worksite. Technical support implementing a smoke free campus policy for one local business, as well as providing support for a local business implementing a Walkable Business Project was done. Worksite wellness coalition meetings and monthly wellness emails for all businesses in the Scottsbluff region were provided.
to receive an immunization against flu without ever having to leave their car. A walk-in flu clinic at St. Mary’s Plaza provided over 300 more residents this protection. One area on which Community Health focuses is providing flu shots at the worksite. In 2014, over 60 businesses held onsite flu clinics for their employees. This resulted in over 1,500 more immunizations against influenza being delivered to residents of Scotts Bluff County. The Injury Prevention Coordinator continues to function in partnership with Trauma Services. Holly Johnston, RN, BSN reaches out to the community with information on the top 10 traumas in the region as well as educating on current hot topics such as distracted driving. This year a focus is a program called “Teens in the Driver’s Seat” where peers within high schools work to educate fellow students on safety driving issues. Regional West Medical Center is one of 100 hospitals across the nation that is contracted with the Consumer Product Safety Commission (CPSC) to review Emergency Department visits for accidents and trauma related to commercial products. This data is supplied to the CPSC and utilized to develop safety recalls for consumers.
Community Health partnered with Regional West Physicians Clinic to provide another annual drivethrough influenza clinic. This event allowed over 500 residents Regional West Health Services | 43
Pharmacy Medication Reconciliation Nurses Pharmacy Nurses • The pharmacy has five RNs who work from the pharmacy and help to verify patients’ home med lists. • They obtain a complete list of the patients’ home medications and allergies and update the electronic medical record for all inpatients. With patients, they review all prescriptions while gathering information on any over-thecounter or herbal products.
Kelsey Kriewald, Pharm D, RPH | Clinical Coordinator, Pharmacy Department
Our pharmacy nurses include: Karla Biberos, RN Tammy Cox, RN Marilee Monohon, RN Molly Shinn, RN Ron Ward, RN
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• While compiling the list, they search multiple online databases to determine the correct medication doses. Online resources utilized include: Nextgen, NeHII, NRX-QS1, Home Health, Hospice, Palliative Care, and HPF. • Pharmacy nurses also contact outpatient pharmacies for information regarding medications and dosages. • After comparing the home medications with the medications ordered in the hospital, they will contact the prescriber to clarify any medication discrepancies. Any medication orders obtained from the prescriber are entered into the electronic record. • The pharmacy nurses have expanded their coverage to better cover surgical patients. They now see patients who will be having surgery and spending the night when the patient arrives for his or her Pre-Admit Testing (PAT) visit. This allows the pharmacy nurse to compile a complete list for the surgeon to review on admission. When the patient arrives in Outpatient surgery, the pharmacy nurse meets with the patient again to review the med list and make
Pharmacy RNs: Karla Biberos, RN; Tammy Cox, RN; Marilee Monohon, RN; Molly Shinn, RN; Ron Ward, RN any changes that may have been made since their PAT visit. •W hile completing the home med list, they also screen patients for vaccinations. Currently pharmacy nurses screen all patients for influenza, pneumococcal, and tetanus/diphtheria/pertussis vaccinations. After the information is obtained from the patient and NESIIS (on-line immunization database), the pharmacy nurses enter the data into the electronic record. If patients qualify for a vaccine and wish to receive the vaccine while they are inpatient, the pharmacy nurse forwards the form to the pharmacist for review and to order the vaccine. •E ach year the pharmacy nurses compile and review home med lists on over 7,500 patients. The pharmacy nurses are available from 6 a.m. to 8 p.m. Monday through Friday and 8 a.m. to 6:30 p.m. on weekends, plus holidays. • Our pharmacy nurses also provide Warfarin (Coumadin) teaching to all inpatients.
Quality Resource The Quality Resource Department consists of 11 employees who support performance improvement, infection prevention, and related quality and safety activities throughout Regional West Medical Center. Seven of the 11 employees are RNs with distinct areas of focus within continuous quality improvement initiatives and regulations. Department staff RNs are: • Janelle Schroeder, MSN, RN – Clinical Quality Improvement (CQI) Nurse Coordinator • Judy Bowlin, BSN, RN - Clinical Data Quality Analyst • Vicky Stoll, RN - Clinical Data Quality Analyst
Perinatal/Peds, M&M, and committee meetings. Additionally, nurses participate in the Root Cause Analysis Team. Each nurse in the department serves as a content expert, resource, and support to other departments. Work highlights of 2014 for the Quality Resource Department: •O ngoing education and training for changes to Core Measures: developed new/updated flip charts, and a Swank education module for nursing staff. •W orked with Paragon builders on documentation to facilitate meeting current Core Measures including patient education requirements.
• Kris Henkel, RN - Clinical Data Quality Analyst
• Meaningful Use collaboration.
• Janice Casey, RN - Clinical Data Quality Analyst
•C oncurrent infection prevention.
• Jeanie Miller, RN, BC - Clinical Data Quality Analyst
•A nnual infection prevention risk assessment.
• Amanda Sabo, BSN, RN – Infection Prevention and Epidemiology Nurse
•O ngoing implementation of the Midas DataVision and Stat It modules.
The nurses have responsibility for aspects of Centers for Medicaid and Medicare (CMS) and Joint Commission (JC) quality reporting requirements including Core Measure chart abstraction, provider and staff education, and Opportunity for Improvement (OFI) reporting. Nurses prepare documents and/or reports for review at a variety of committee meetings, including Medical, Surgical, and
•O ngoing procedural sedation documentation improvement audit.
Margo Ferguson, MT (ASCP) | Director, Quality Resource
•Q uality Resource rounding on care units.
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Fall Prevention Team The Fall Prevention Team is responsible for facilitating the fall prevention program and ensuring standards of practice are adhered to throughout patient care areas at Regional West Medical Center.
Responsibilities Overview 1. O versight for the review and revision of falls prevention policies and procedures on a periodic basis. 2. E valuate the effectiveness of all fall prevention activities including assessment; interventions; and patient, family and staff education.
Janelle Schroeder, MSN, RN | CQI Nurse Coordinator
•O ngoing analysis of current processes, and: - Process steps evaluated for high-risk, high probability of failure, low value, or redundancy. - Process modification to improve effectiveness. - Develop and/or revise Policy and Procedures.
3. C ommunicate and collaborate with other groups and appropriate committees of fall prevention activities and updates.
• Fall risk assessment procedure
4. P rovide recommendations to organization leadership and staff on equipment and environmental safety.
- Job aid development that’s published on the Regional West Medical Center home page.
• Post-fall huddle procedure • Post-fall care protocol
- Monthly case review.
2014 Accomplishments • T ransition of falls prevention oversight to multidisciplinary team. • Establish baseline data. - O utcomes and process metrics identified and linked to Regional West Medical Center’s strategic plan and performance improvement plan. •A ll-staff education and housewide implementation of the Hendrich II Fall Assessment Model®.
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- Manager rounding process and tool development. - Ongoing data collection and analysis. •F all Prevention Team dashboard • Action plan
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Fall Prevention Team (cont.) Membership Executive Sponsors Shirley Knodel, MS, RN
Chief Nursing Officer
Jonathan Morgan, MD
Chief Medical Officer
Leadership Co-chairs: Sarah Shannon, BSN, RN, CMI-Spanish Margo Ferguson, MT (ASCP)
Director-Nursing Support Director-Quality Resource
Safety Coach: Susan Backer, MSN, APRN-CNS, ACNS-BC
Patient Safety Officer
CQI Manager: Janelle Schroeder, MSN, RN
Quality Resource
Recorder: Becky Nerud
Administrative Secretary
CHAMPIONS Department
Management Representative
Front-Line Staff Representative
2nd East
Diana Baratta Stacey Powell Rebecca Montanez Chris Buhr
Daler Zabirov
2nd West
Cynthia Wurdeman
3rd Floor
Jennie Knode
Acute Rehab
Tami Bokelman
Darlene Cooper
Behavioral Health Unit
Mary Armstrong
Penny Thomas
Birth & Infant Care Center
Jessica Kortmeyer
ICU/PCU
Nancy Hicks-Arsenault
Pharmacy
Kelsey Kriewald
Physical Therapy
Amy Mikesell
Endoscopy Risk Management
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Rebecca Hubbard
Amber Gomez Joanne Phillips
Imaging Services
Kari Flom
Scottsbluff Surgery Center
Leslie Cook
Risk Management Joanne Phillips, MS, RN, CPHRM, CPHQ was hired in November to fill the director of Risk Management role which had been vacant. Joanne has been a registered nurse for over 25 years with a clinical background in emergency and critical care nursing. The last 10 years she has focused on Risk and Compliance. She has obtained her masters degree in Health Law and is currently enrolled in a doctor of education program in organizational leadership with an emphasis in health care administration.
Joanne has met with most of the nursing directors and managers and has attended risk and insurance training with Western Litigation in Denver. Areas for education have been identified and plans for CNE education as well as unit education are in progress. She works closely with Connie Ruff, Guest Relations
director. Please do not hesitate to call for any risk related issues or concerns, and she can be reached at 308.630.2895. If you have any Guest Relations concerns please call Connie Ruff at 308.641.7556.
Joanne Phillips, MS, RN, CPHRM, CPHQ | Director, Risk Management
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Trauma Services Regional West Medical Center is a Level II Trauma Center, and has been verified by the American College of Surgeons since 1996. Regional West is the lead Level II Trauma Center in Region 4 of the State of Nebraska. Region 4 has 10 Critical Access Hospitals that Regional West Medical Center supports in training the roles of trauma medical directors, trauma nurse coordinators, and trauma registrars. We held our Region 4 Performance Improvement meeting in March and October 2014 at Regional West Medical Center The Trauma Services Department includes Rommie Hughes, MD, Trauma Medical Director; Shermaine Sterkel, RN, Trauma Program Manager; Deana Spreier, Trauma Registrar and Performance Improvement (PI) Coordinator; and Holly Johnston, RN, Injury Prevention Coordinator.
Shermaine Sterkel, BSN, RN, CCRN | Trauma Nurse Coordinator
In 2014, Regional West Medical Center treated 593 trauma patients. Of those patients, 293 were trauma team activations with 63 full trauma team activations and 125 partial trauma team activations. Deana enters all of the trauma patients into the trauma registry and performs 100 percent review of the cases for performance improvement opportunities. This information determines the trauma cases
that go to review at Trauma PI and Patient Safety (TPIPS) as well as to Trauma Peer Review (TPR). Deana also has responsibility and oversight of approximate 275 trauma patients and their data that is entered into the trauma registry of our 10 Region 4 hospitals. In January 2014, Trauma Services changed to a new trauma registry called Image Trends. Image Trends interfaces with our pre-hospital electronic documentation, referring hospital registries and the state of Nebraska trauma registry. Image Trends also supports TQIP--Trauma Quality Improvement Program by the American College of Surgeons (ACS). TQIP’s goal is to improve the quality of care of trauma patients, identify best practices,
In 2014, the top 10 causes of injury from most to least were:
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1
Falls
2
Motor Vehicle Crashes (MVC)
3
Livestock related
4
Motorcycle Crash (MCC)
5
All-Terrain Vehicles (ATV)
6
Assault
7
Motor pedestrian
8
Sports related
9
Farm/heavy equipment incident
10
Bicycle crash
and facilitate external benchmarking. Some process of care measures include Traumatic Brain Injury (TBI), Venous Thromboembolism Prophylaxis (VTE), hemorrhage control, blood transfusion measurement, and withdrawal of care.
Trauma Services is also working with our Marketing Department on a formal marketing plan to facilitate outreach of our Level II Trauma Center and our compliment of surgical services that take care of our trauma population.
Holly Johnston, Injury Prevention Coordinator, made presentations to students at Gering High School about “Teens in the Driver Seat�. Regional West Medical Center, Trauma Services, and Air Link teamed up to march in the Oregon Trail Day parades with themes of safety and injury prevention.
The entire trauma team at Regional West Medical Center deserves recognition for the excellent trauma care of some very critically injured patients and the awesome outcomes. Thank you all for everything you do to give the quality care to our patients, family, and friends.
Trauma Services had our reverification visit by the American College of Surgeons as a Level II Trauma Center in November 2013. Trauma Services is preparing for a Focused Review visit in February 2014 by the ACS since the implementation of the new trauma registry and TQIP.
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Education Department Kim Meininger, BSN, RN | Clinical Coach Coordinator/Educator
2014 Core Curriculum for Clinical Coaching
Top row L to R: Dallas Schaffer, Julie Schaff, Kim Meininger. Bottom row L to R: Carrie Snygg and Carol Gifford
Three clinical coaching workshops were completed in 2014. These two-day workshops are designed to educate existing staff that are interested in becoming preceptors or “clinical coaches” and have the desire to mentor others. To develop the capabilities to be a clinical coach, one must learn roles and responsibilities, teaching and learning theories, plus be able to demonstrate the dynamics of collaborative teamwork towards patient centered care. The roles and responsibilities of the preceptor or clinical coach are to be: 1. A protector for the patient and newly hired nurse 2. An evaluator to validate competencies 3. A socializer and team leader to support teambuilding and assist with integration into the workplace environment 4. A role model with self-development while demonstrating respect for others’ values and beliefs 5. An educator
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The educator responsibilities of the clinical coach are to assess learning needs and promote critical thinking with clinical reasoning. Each staff member that has completed this specific training receives a specialty pin with colored beads. With placing “color” to our learned concepts, we provide a continual reminder for the clinical coach’s responsibilities. 1. Purple = Protector Passionate about protecting 2. Yellow = Evaluator Turn lemons into lemonade! 3. Green = Educator Growing new staff 4. Red = Role Model Stop and watch me 5. Blue = Socializer Keep staff from becoming blue A total of 22 staff members from multiple nursing units attended the workshops. When you see a “colored concept pin” on each of these coaches’ name badge, please thank them for their dedication and passion in building the nursing profession!
Carrie Snygg, BSN, RN | Clinical Nurse Education Coordinator/Educator Regional West Health Services is an approved provider of continuing nursing education by the Nebraska Nurses Association, an accredited approver by the American Nurse Credentialing Center’s Commission on Accreditation. The Education Department includes a director, two nurse educators, two education coordinators, and a secretary. In 2014: • 120 nurses participated in peer-reviewed nursing contact hours. • 7 different peer-reviewed activities were offered. • 18.25 different live peerreviewed contact hours were offered. •5 56.5 peer-reviewed nursing contact hours and physician CMEs were completed on SWANK Health through Regional West Medical Center. The Education Department coordinated opportunities for panhandle health care providers to certify or renew certifications in the following classes. A large number of participants were Regional West nurses.
Advanced Cardiac Life Support Three provider courses and eight recertification courses were offered. • Provider (certification) = 54 participants • Renewal (recertification) = 106 participants • Total = 160
Pediatric Advanced Life Support
Regional West's clinical coaches
Four provider courses and seven recertification courses were offered. •P rovider = 38 participants •R enewal = 77 participants •T otal = 115
Trauma Nurse Core Course Four courses were offered. •T otal participants = 57
Neonatal Resuscitation Course Twelve courses were offered. •T otal participants = 31
Emergency Nurse Pediatric Course Four classes were offered. •T otal participants = 57 Our Education Department works with the Rural Nebraska Healthcare Network to provide these and other learning opportunities, not only at Regional West but also across the panhandle.
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Shared Governance Reports Jacqulyn Robison, BSN, RN, GRN | Survey Preparedness and Magnet Coordinator
Coordinating Council Care and Practice Council MISSION The Shared Governance Coordinating Council will collaborate to lead, coordinate, and communicate the activities of nursing Shared Governance Councils to keep patient care the central focus of all we do.
VISION We are the voice of nursing staff by facilitating communication, collaboration, support, delegation, leadership, and education through Shared Governance.
VALUES Empowerment Responsibility Accountability Shared Decision-making
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Quality and Safety Council MISSION To promote and maintain best practices for patient safety and quality care.
VISION Outcomes measures consistently outperform benchmark data.
2014 Quality & Safety Committee Highlights During 2014, the Quality and Safety Committee worked intensely on the health care work fatigue project. A timeline was projected to include the steps of the following: 1. S urvey draft and submission for the project. 2. P roject overview. 3. A nalyze results. 4. M ake recommendations. 5. D evelop education to house wide staff that is evidence-based on reducing health care worker fatigue and the potential for medical errors. House wide, a survey was sent to not only nursing staff, but to all the different health care positions to inquire what type of shift they worked, how many shifts in a row they worked, and how breaks/meal breaks were handled while working in the direct patient care setting. The premise for this project was to produce results of those who may not feel they can take time away from their patients for a break, work overtime, and work various shifts that impact their performance.
After the results of this project were collected, the council met with the directors and Regional West leadership to share the results, and with that they implemented including incident reporting (known as MIDAS), tracking if a medical error was due to fatigue.
Michelle Powell, BSN, RN
Recommendations that were noted included implementing a formal process for meal breaks, encouraging staff to get off of the unit during break time, flexible shift length if possible, discouraging more than three or four shifts worked in a row, and investigating ways to decrease the number of hours that staff worked over 14 hours straight.
Chair
As 2014 wraps up, the council is completing the recommendations and offering education to staff and leadership through this project on ways to improve health care worker fatigue. Education is currently being developed that is evidencebased. The goal is to promote staff satisfaction and keep strong the quality and safety of care that is provided to the patient population at Regional West.
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Professional Practice Council MISSION The Professional Practice Council’s mission is to promote and support the professional nurse through a positive work environment and staff development activities.
2014 Professional Practice Committee Highlights
Tara Shallenberger, BSN, RN Chair
Standardized nursing uniforms: The Professional Practice Committee has reviewed the survey results from the color-coded uniform pilot study. Due to over 58 percent of patients feeling they were able to more easily identify their RNs due to wearing a single color, the committee has recommended that we move to standardized uniform colors for all nursing disciplines. RNs will stay with the pewter color that was used in the pilot study, and the LPNs and CNAs will vote for the color they will be wearing. It was decided to implement this change on Aug. 1, 2015 to give everyone time to purchase their uniforms. It was decided that there would be an allowance for holiday themed scrubs around certain holidays. RN clinical ladder: Some directors voiced concern about our current clinical ladder, and said that they
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would like it to be more "outcomes based." The Professional Practice Committee was thinking about going to a totally new ladder, based more on points. But this would take numerous hours, and with the standardized uniforms coming, and all of the work that our committee will be doing on that, we did not feel doing both would be feasible this year. We had a meeting with all the unit managers and found out that they did not feel like we needed a new clinical ladder, but that everyone needed more education about our current clinical ladder. They also did not feel like the clinical ladder should be mandatory as they spent way too much time chasing people around trying to get them to turn in their ladders. Making the clinical ladder not mandatory is currently under consideration.
Care & Practice Council MISSION Promote, facilitate, and coordinate patient care.
VISION The council is actively seen and utilized as a resource for patient care issues to ensure superior clinical performance resulting in outcomes that outperform benchmark data.
2014 Care & Practice Committee Highlights
the decisions on what they should order.
During 2014, Care & Practice spent the year working on educational updates and training of the basics of documenting patient intakes and outputs as well as daily weights needed for physicians when making critical decisions on how to proceed with treatment. In the world of nursing, we understand the importance of accurate documentation and reporting on our patients and their signs/symptoms. Making sure we document accurately on our patient population when it comes to their fluid balance is crucial to the documentation process for provider to make
The research has been collected on how to best educate the frontline nursing staff population on some refresher information when it comes to documenting the I & Os as well as daily weights. The group has set a goal to release a PowerPoint education through Swank by the beginning of 2015. In the end, the common ground to be gained is patient safety through nursing documentation and reporting to providers when it comes to fluid balance and vital signs.
Liz Ossian, BSN, RN Chair
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Night Shift Council MISSION The Shared Governance Night Council will focus on evidence-based behavior, environment, and practice changes to influence patient satisfaction scores, consistently achieving top-box score in all areas.
VISION Excellent patient satisfaction scores as a result of change, researched and initiated by Night Shift Council.
2014 Night Shift Committee Highlights
Matt Blaylock, BSN, RN Chair
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Night Shift Council has been working on ways to improve food cart at night and also giving night shift staff some other options for food. They have also been researching nurse bullying and ways other hospitals have implemented plans to stop this from happening. Currently they are trying to recruit more members for the council. Any nurse from Regional West Medical Center who
works the night shift is invited to participate in this council and help facilitate ways to improve processes or lift up comradery for night shift staff members. Nurses who work the night shift can be a “forgotten population,� but the dedication and commitment they make in working overnights is something that is important and imperative in serving the community and patient population.
Nurse-Finance Council The Nurse-Finance Council was created in 2013. The common goal from the Nursing Department and Finance Department is to collaborate on ideas that create a cost-effective environment here at Regional West. This would include ways to become more efficient in labor costs and with the use of medical supplies.
MISSION Nurse-Finance Council will serve as a collaboration to optimize fiscal responsibility across all areas of nursing while maintaining the delivery of safe, quality, and efficient patient care.
VISION Cost effective management of labor and supply resource utilization.
2014 Nurse-Finance Council Committee Highlights The Nurse-Finance Council was able to move to the reusable blood pressure cuffs for patient use which helped cut down on costs. ICU/PCU also had their menus laminated so that they could reuse them instead of printing off new menus after each patient. The cost per laminated menu was only $1.25 and the menus are wiped down after each patient dismissal for infection control purposes.
of initiating a recycling program that would promote a “healthy hospital� while going green for the environment. There is also some opportunity to see if the hospital can make money back by sending their recycling to Gering. This initiative is just in the beginning stages of its process so there are more good things to come.
Vickie Schmall, BSN, RN Chair
Other initiatives that began in 2014 and will continue into 2015 are looking at the ways to recycle. Director of EVS Mike Parker presented the group with the idea
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2014 Regional West Medical Center Certified Nurses Accredited Case Manager (ACM)
Shermaine Sterkel Marilyn Stoddard
Lois Cannell Stephanie Hawley Karen Houk
Certified in Electronic Fetal Monitoring (C-EFM)
Antigua & Barbuda Midwifery Association Claudia Mack-Simon
Certified Ambulatory Perianesthesia Nurse (CAPA) Michelle Keener Roxie Shaul
Certified Bariatric Nurse (CBN) Ramona (Mona) Urwin
Certified Case Manager (CCM) Jackie Carter
Certified Clinical Health Coach (CCHC)
Stacy Ingersoll (dual certifications)
Vivianna Palomo (dual certifications)
Certified Inpatient Obstetrics Nurse (RNC-OB)
Certified Emergency Nurse (CEN)
Mary Coon Ramona Giles Robin Cushing
Melissa Amateis Linda Borelli Alice Fillingham Linda Fowler (dual certifications) Trisha Garner (dual certifications) Erin Hill Kathy Jacobson Lori Joplin Amanda Lashley Sherry McDonald Tom Moore Laura Wolfe Sarah Paetow
Pamela (Pam) Zitterkopf
Certification in Field Epidemiology
Certified Critical Care RN (CCRN)
Paulette Schnell
Joshua Beals Jessica Conn Jacqueline (Jackie) Delatour Linda Fowler (dual certifications) Travis Hargreaves Cheryl Hoxworth Stephen Matthews Leigh Miller Cheryl Patrick Teal Smith
Certified Flight Registered Nurse (CFRN) Trisha Garner (dual certifications) Tracy Meyer Jason Rairigh Sean Shirley Dee Vogel
Certified Gastroenterology Registered Nurse (CGRN) Lucrecia Spady
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Certified High Risk Neonatal Nursing
Certified Lactation Counselor (CLC) K eara Brunner Stacy Ingersoll (dual certifications) Cynthia Francisco (dual certifications) Vivianna Palomo (dual certifications)
Certified Medical Interpreter (CMI-Spanish) Sarah Shannon J. Martin Vargas
Certified Nurse Operating Room (CNOR)
Dayna Dondelinger Rhonda Goshens Darcy Haslam Christy Jay Colleen Kelly Mary Lockwood Kim Mann Janet Lewis Kim Brown Leslie Ilg Joann Walte Nate Walker
Certified Perianesthesia Nurse (CPAN)
Gerontology Nurse Certified (BC)
Irma Walter
Sandy Hebbert Peg Jackson Billie Kniss Katharina Lemons Tracy Payne Chris Micheels Andrea Ray Roxie Shaul Michelle Keener
Certified Professional Utilization Reviewer (CPUR) Julie Kautz Kristi Henkel
Certified Rehab Registered Nurse (CRRN) Darlene Cooper Pam Cover Cindy McGaughy
Certified Wound Ostomy Continence Nurse (CWOCN) Jeanette McFeely Rachelle Noe
Clinical Nurse Specialist Adult Health and Illness (ACNS-BC) Susan Backer
Emergency Medical Tech-Basic (EMT-B) Vanessa Rhembrandt
GI Technical Specialist Certificate from Society for Gastroenterology, Nurses and Associates (SGNA) Donna Klein, LPN Kathy Mackrill, LPN
International Board Certified Lactation Consultant (IBCLC) Cynthia Francisco (dual certifications)
Medical-Surgical Board Certified Nurse (CMSRN)
Delfina (Tina) Delgado Lisa Fabricius Michelle Powell Tara Shallenberger Christina Walters
Peripherally Inserted Central Catheter (PICC) Insertion Certification John Beard Mike Bokelman
Psychiatric and Mental Health Certified Sheli Goodwin Tamara (Tami) Lewis
Resident Assessment Coordinator – Certified (RAC-CT) Sheila Kihlthau
Sexual Assault Nurse Examiner/Sexual Assault Forensic Examiner (SANE/SAFE) Mandy Shaul-Bolek
Oncology Certified Nurse (OCN) Megan Anderson Leslie Biggs Susan Schoeneman
Orthopedic Nurse Certified (ONC) Christine (Chris) Buhr Kim Meininger
Outcome Assessment Information Set Certified Nurse (OASIS) Michelle (Shelly) Meisner
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Regional West Health Services 4021 Avenue B | Scottsbluff, NE 69361 P 303.635.3711