celebrating nursing - bronson health

CelebratingnursingExcEllEncE2012 | A YEAr in rEviEw

about bronson Methodist HospitalBronson Methodist Hospital, located at 601 John St. in downtown Kalamazoo, MI, is the flagship of Bronson Healthcare, a not-for-profit healthcare system serving all of southwest Michigan and northern Indiana. With 434 licensed beds and all private rooms, Bronson Methodist Hospital provides care in virtually every specialty — cardiology, orthopedics, surgery, emergency medicine, neurology, oncology — with advanced capabilities in critical care as the only Level I Trauma Center in southwest Michigan; in neurological care as a Joint Commission certified Primary Stroke Center; in cardiac care as the region’s first accredited Chest Pain Emergency Center; in obstetrics as the leading BirthPlace and only high-risk pregnancy center in southwest Michigan, and in pediatrics as one of only six children’s hospitals in the state.

2012 Selected Achievements

•HealthgradesDistinguishedHospitalforClinicalExcellence™

•HealthgradesEmergencyMedicineExcellenceAward™

•HealthgradesOutstandingPatientExperienceAward™

•Becker’sHospitalReview‘100GreatHospitalsinAmerica’

•TheLeapfrogGroup’s“A”HospitalSafetyScoreSM

•GetWithTheGuidelines™PlatinumPerformance,HeartFailureGoldPerformance,andStrokeSilverPerformanceAchievementAwards

•BlueDistinctionCenter+forSpineSurgeryandKnee/HipReplacement

•UnitedHealthPremiumSMCardiacSpecialtyCenter

•MagnetHospitalDesignation

•LevelITraumaCenterVerification

•PrimaryStrokeCenterCertification

•ChestPainCenterCycleIIIAccreditationwithPCI

•Working Mother’s“100BestCompaniesforWorkingMothers”

Cover photo donated by Overneath Media in honor of a special nurse.

a Message from the Chief nursing Officer

Celebrating nursing exCellenCe 1

We hit the ground running in 2012 and haven’t stopped!

Several best practices were implemented hospitalwide — bedside

handover, purposeful rounding and daily huddles. Nurses researched

the effectiveness of these practices and found they increase patient

satisfaction and patient safety. Now, we’re continuing to build on the

momentum and positive results!

In May, the entire hospital implemented Bronson’s electronic health

record, Epic. This was no easy feat! Teams worked round the clock

to support patient care. Nurses took the lead in identifying issues

and suggesting solutions to improve process and care at the bedside.

This led to the formation of a special Nursing Informatics Committee

to help prioritize requests and share updates. Throughout the

transition from paper to electronic charting, nurses continued to

provide excellent healthcare in partnership with patients and families.

This is what nurses at Magnet hospitals do — rise to the challenge,

embrace it, and excel!

Professional development also continued as many nurses went back

to school, achieved certification, and conducted evidence-based

research. Shared governance councils worked as teams to solve unit

opportunities for improvement and recognize each other. This is the

future of healthcare and the future of nursing — identify issues, be

a part of the solution, share your skills and expertise, research what

works best, and constantly strive for excellence. I believe we have the

staff here at Bronson to do just that. Congratulations on a successful

2012 and I look forward to your many

achievements in 2013!

Vice President, Chief Nursing Officer (CNO)

Bronson Methodist Hospital

transformational leadership

2 2012: a Year in review

Strategic PlanningCNODeniseNeely,MBA,BSN,RN,presentedBronson’s2013–2015SystemPlanforExcellence(PFE),

goals,2013NursingStrategicPlanandroughdraft2013NursingQualityPlantoDivisionalNursing

SharedGovernanceCouncil(DNSGC)andNursingQualityImprovementSteeringCommittee(NQISC).

DNSGCandNQISCwereremindedthatBMH’sPFEgroundsthemission,visionandvalues,organizes

workandkeepseveryonefocusedonthesamepriorities.Thismakesitimperativetohavenursing’s

strategicplanandgoalscascadefromthesystemplan.Neelyledbothgroupsindiscussionregarding

whatnursing’sprioritiesshouldbein2013.Inputobtainedhelpeddevelopthe2013NursingQuality

Plananddefinenursingscorecardindicators.

© 2012

2013 Nursing Strategic Plan “Operating at Best Practice”

2013 Nursing Objectives

2013 Entity Objectives & Tactics

Clinical Distinction Exceptional Customer Experience

Corporate Vitality Community Health Catalyst

7. Improve financial performance

8. Reduce delays through optimizing capacity and utilization

Community Health Catalyst

6. Actively participate to improve the health of residents in our region

3.Achieve top decile in patient engagement

4.Achieve top decile in staff engagement

1. Achieve top decile in quality

2. Achieve top decile in safety

Clinical Distinction Exceptional Customer Experience

Corporate Vitality


Advocacy and Influence

Directors/Managers Advocating for Technology Resource WhileattendingtheAmericanNursesCredentialing

Committee(ANCC)NationalMagnet®Conference

inOctober2011,TinaSullivan,MSN,RN,NE-BC,

directorofnursing,obtainedinformationaboutThe

C.A.R.E.Channel.Thisprograminterfaceswiththe

patienttelevisionsystemtoprovidepatientsaccess

tonaturescenesaccompaniedbyinstrumentalmusic,

guidedimageryexercisesandprogramstoassistwith

sleep.Researchandpatientsatisfactiondatahave

shownsoundandotherenvironmentalfactors,such

asTheC.A.R.E.Channel,significantlyimpactclinical

resultsbycreatingacalmandhealingenvironment.

Hospitalsusingthissystemhavereportedreductions

intheuseofpainmedicationandrestraints,a

decreaseinthelevelofnoiseontheunits,aswellas

improvedqualityofrestforpatients.Thisevidence

enabledSullivantoobtainoverwhelmingsupport

toimplementtheprogram,whichbecameavailable

topatientsviain-roomtelevisioninMayof2012.

Nursinghasreceivedpositivefeedbackfrompatients

viawrittennotesandverbalcommentsduring

PatientandFamilyAdvisoryCouncilunitrounds.

Direct-Care Nurses Advocating for Technology Resources Mid-year2012,multiplemembersoftheGeneral

SurgeryUnit(GSU)andNeurovascularUnit(NVU)

nursingstaffidentifiedtherewasashortageof

bladderscanners.Theincreaseduseofthescanner

wasbeingdrivenbychangesintheFoleyprotocol

anddecreaseduseofurinarycatheters.Nurse

managers,MarkMesser,BSN,RN,andJoshuaRuhrup,

BSN,RN,advocatedattherequestofthenursesby

addingabladderscannertobothGSUandNVU2012

capitalbudgets.Therequestwasapprovedandtwo

additionalscannerswerepurchasedin2012.

transformational leadership


Reduce Medication Errorsthat Reach the PatientThismultidisciplinarygroup,chairedbyCNODenise

Neely,MBA,BSN,RN,isleadingtheefforttoreduce

thenumberofmedicationerrorsthatreachthe

patient.Themedicationerrorcommitteeincludes

membersfromNursing,Pharmacy,RiskManagement,

InformationTechnologyandQualityandSafety

leadership.Duringtheweeklymeetings,every

medicationerrorthatreachedapatientisdiscussed

usingajustcultureapproach.Ifsystemfailuresare

therootcauseoferrors,immediateactionistakento

address.Leaderssharepatternsofmedicationerrors,

suchasnotfollowingthefiverightsofmedication

administration,withstaffnursesduringmonthly

staffmeetings.Thisgroup’sdedicationiscreating

asaferenvironmentforourpatientsasmedication

errorsthatreachedthepatientwerereducedby

15percentin2012.

Daily HuddlesIn2012,theDivisionofNursingimplementeda

safetybestpractice—dailyhuddles.Huddleslast

approximatelyfiveminutesandpossessthreemain

elements:criticalcommunication,reviewofdaily

metricsandideasinmotionorstaffinput.Nurse

managersandstaffcollaboratedtodefineunit

specificelementsandcreate

huddleboards.

“They’re working great!

The off-going charge

nurse does the huddle

on the unit every day

at 7 a.m. and 7 p.m. It

only takes a couple of

minutes and provides

a great way for our unit to know what’s

happening with safety issues, staffing, census

and goals. In fact, some of the residents listen in

so they have a sense of the big picture as well.

The daily huddle is one more tool to improve

communication among staff and leaders.”

Marla Atkinson, MSN, RN NursemanageroftheOrthopedicSurgicalUnit(OSU)

15%reduction

in medicationerrors


Visibility, Accessibility and CommunicationsBronson’sCNOinteractswithstaffnursesinmanyways:

•CNOopenhousehours

•Monthlypatientsafetyrounds

•“HotTopics”atthemonthlyDivisionalNursingSharedGovernanceCouncil

•CNOonthefloor

•Monthlyemailsandnewsletter

•Leadershiprounding

•Focusgroups

Thefollowingchangeshavebeenmadebasedoninputfromdirectcarenurses:

•EmergencyDepartmentputtogetheramultidisciplinarygrouptostreamlineoverflowplanintoEndoscopy

•NewhiresreceiveEpicaccessmorequickly

•NursingNotesmodifiedtostreamlinenursingcommunicationanddecreasethetotalnumberofemailsstaff

receives

•MeetingsheldweeklytodiscussEpicconcernsandimprovecommunicationregardingEpicchanges

•Staffingpolicyreviewedandupdated

•Unitdailyhuddlesimplemented

structural empowerment


Professional EngagementBronson’snursingsharedgovernancestructure

empowersstaffby:

•Placingdecision-makingatthelevelclosesttothe

situation

•Improvingcommunicationandcollaboration

•Promotingexcellenceinclinicalpractice

•Supportingprofessionaldevelopment

•Sharingof

bestpractices

Divisional Nursing Shared Governance CouncilTheDivisionalNursingSharedGovernanceCouncil

(DNSGC)bringstogethernursingunitrepresentatives

acrosstheorganizationinordertocoordinate,

communicateandfacilitatethepracticeofnursing.

Thisisaforumforissueidentification,information

sharing,staffeducationandinput.InOctober2012,

KathyHowland,a

patientandfamily

advisor,became

amemberofthe

DNSGC.Adding

Howlandensuresthe

patient’svoiceisheard

andhelpsbringBMH’s

ProfessionalPractice

Modeltolifeby

keepingpatientsand

familiesatthecenter

ofourdecision-making.

Clinical Quality CommitteeTheClinicalQualityCommittee(CQ)isresponsible

foreducatingandinitiatingsystemwidequality

initiatives.Theycoordinatetheireffortswith

othercouncilstoensurethehighestlevelofcareis

providedtopatientsserved.

In2012CQprovidedinput,developedand/or

implementedthefollowing:

•Abnormalvitalsignpolicyand‘help’tool

•Medicationdistractionpilot

•TEMProundingtabinEpic

•Narcoticlockboxselection,policyupdate

•Aspirationpneumoniaandoralcarepolicyupdate

•HemodialysisUnitflowenhancements

Professional Practice CommitteeProfessionalPracticeCommittee(PPC)isdesignedto

supportprofessionalnursingpracticeandprovide

aninfrastructurewhereBronsonnursescanachieve

theirprofessionalgoals.Italsorecognizesand

celebratesnurses’success.

PPC2012Accomplishments:

•12DAISYawardwinnersselected

•70NursingProfessionalAdvancementLadder

(NPAL)bindersreviewedandapproved

•Nurses’Weekcelebration

•RNpeerreviewtoolupdated

•Nurseleaderbasicsstreamlined

•SocialmediapresentationbyKatePayne,BSN,JD,

MA,RNfromEthicsConsultantGroup,LLC


Advance Practice Nurse (APN) CouncilPromotesandsupportsAPNpracticethroughoutthe

Bronsonorganization.

Thecouncilachievedthefollowingin2012:

•Reviewedandmaderecommendationsfor

credentialingandprivilegingtocredentials

committee:sixcertifiedregisterednurse

anesthetists,ninenursepractitionersandtwo

certifiednursemidwives

•APNCouncilleadershiprepresentativeattended

monthlycredentialscommitteemeetingsand

providedrecommendations

•UpdatedAPNsectionofnursingsharedgovernance

bylaws

•Approvednewclassificationforcriticalcarenurse

practitioner

•MaderecommendationsonEpicco-signaturepolicy

•Approvedcoreandnon-coreprivilegesfordoctorof

nursingpractice

•Createdadvancedpracticeinternposition

•Reviewedandupdatedcredentialingprocess

algorithm

•HeldquarterlyAPNbreakfasts

°March:Epicexperiencesandsuggestions

°June:KathleenLavery,MS,RN,CNM,

chairperson,MichiganBoardofNursinggave

presentationon“AdvancePracticeNursesand

the2012MichiganStateLegislation”

°September:MitziM.Sanders,PhD,RN,ACNS-BC

presented“RoleoftheClinicalNurseSpecialist”

°December:KathleenLavery,MS,RN,CNM

provided“NursingLegislativeUpdate”


Thecouncilachievedthefollowingoutcomesin2012:

•BronsonMethodistHospital

namedanExemplarNICHE

sitebytheHartfordGeriatric

InstituteatNewYork

University

•NICHEAGEducationclasses:

79nursesattended

•NICHEPCAclasses:8patient

careassistantsattended

•Certifications:8newlycertified

gerontologicalRNs/AmericanNursesCredentialing

Center(ANCC)

•Geriatricpatientcareinformationaddedtoprocedure

T-01a, Range Orders for Medications Policy

•FallpreventionpresentationstoDNSGC

•Sleepdisorders,Problemswitheatingandfeeding,

Incontinence,Confusion,Evidenceoffalls,Skin

breakdown(SPICES)toolembeddedintoEpic

documentation

•ShoppingInserviceMallPosterpresentations:Morse

FallRiskTool,TheConfusionAssessmentMethod

•HartfordGeriatricInstituteonlineNICHE Leadership

Training Program:21newsitesmentoredinNICHE

ProgramDevelopment


Nurses Improving the Care for Health System Elders (NICHE) CouncilFacilitatesholisticcaretotheolderadultpatientpopulationandtheirfamiliesacrosstheorganization

Nursing Research CouncilServestosupportnursingresearchandevidence-based

clinicaldecision-making.

In2012,theNursingResearchCouncil

coordinated:

•TwoNursingResearchRoundtable

DiscussionspresentedbyNatasha

Watson,MSN,RN-C(Interruptions During

Medication Administration)andVivien

Mudgett,MSN,MA,BA,RNC(The Effect of

a Scripting Intervention on the Self-Efficacy

of Nurses who Experience Bullying Behavior

at Work)

•Presentationofascholarlywritingworkshop

byKarenMorin,DSN,RN,ANEF,FAAN

•Reviewofsixnursingresearchproject

proposalsinthedomainsofclinicalpractice,

leadershipandeducation

•MentorshipforBronsonnurseinvestigators


Commitment to Professional Development2012 CertificationsCertificationvalidatesprofessionalspecialtyknowledge,skillsandexpertise.Thissupportsprofessional

nursingpracticeandBMH’sProfessionalPracticeModelbyencouraginglifelonglearning,establishing

awell-definedbodyofknowledgeanddevelopingspecializedskillsuniquetotherole.Researchshows

nurseswhoobtaincertification:

•Demonstrateincreasedautonomyandempowerment

•Experiencebettercareeradvancementandmarketability

•Possesshigherself-esteemandconfidenceinabilitytodetecttheearlysignsandsymptomsofcomplications

withtheirpatients

•Reportenhancedcollaboration

•Scorehigherinareasofteaching/collaborationandplanning/evaluationonevaluations

The following staff obtained certification in 2012:

RebeccaBollinger,BSN,RN,ONC OrthopedicSurgicalUnit(OSU)

GwendolynBoyle,BSN,RN-BC EducationServices

GeraldCarpenter,RN-BC AdultMedicalUnit(AMU)

MichelleColyer,MSN,CCRN MedicalIntensiveCareUnit(MICU)

ElizabethHowe,RN-BC AMU

EmilyIngram,BSN,RN-BC AMU

MikeKoehler,MSN,RN-BC,CCM CaseManagement

AnneMaihofer,MSN,RN-BC,CCRN,AACN EducationServices

LorraineReasner,RN-BC,CNOR EducationServices

DonRitchie,BSN,RN-BC AMU

MelissaRobbins,BSN,RN-BC AMU

KenRourke,RN,CEN Trauma&EmergencyCenter(T&EC)

LindaRus,MSN,RN-BC EducationServices

EmilySnyder,BSN,CCRN MICU

AmyStros,BSN,CCRN MICU

AprilVanDerSlik,BSN,RN,CIC InfectionPrevention

Nursing RecognitionDAISY AwardsPPCreviewsDAISYnominationsquarterly

andawardsthreestaffnurseswhogoabove

andbeyondtheirnormalduties.DAISY

Awardrecipientsareselectedbasedonthe

nominationcriteria:

•Makeaspecialconnectionwiththepatient

andfamily

•Includepatientsandfamilyintheplanning

oftheircare

•Doanexcellentjobeducatingpatientsand

theirfamilies

•Makepatientsandfamiliesfeel

comfortable



Don Ritchie, BSN, RN-BS

AMU

“Once in a while someone

crosses our path that truly

stands out from the rest. I am

talking about a nurse by the

name of Don.”

Amy Saylor, BSN, RN

MICU

“Amy showed heartfelt care

and compassion to patient

and family members.”

Pete Olsen, RN, CRNFA, CNOR

Surgery

“Pete is right there, walking

us through it, holding our

hand, giving us guidance

throughout the scary OR

experience. You could say we

have our own private nurse.”

Kelli Witters, RN

General Surgery Unit (GSU)

“Bec[ause] he was scared she

made sure everything was

comforting to him and made

sure I understood everything.”


Bo Pastorick, BSN, RN

MICU

“When I left the hospital on

Sunday evening and Bo was

working, I knew my dad was

in good hands and there was

nothing to worry about, the care

would be nothing but the best.”

Brandi Benthin, BSN, RN

Obstetrics/Mother Baby Unit

(OB/MBU)

“She went out of her way for

me by getting me coffee in

the middle of the night. She

just really was a sweet caring

nurse. She made my stay very

enjoyable.”

Susan Hamilton, BSN, RN

Cardiology

“Susan was a gift and shows

her skill, knowledge and

education with the utmost of

compassion. Bronson should be

proud and honored that she

works for them.”

Jennifer Hamilton, RN

MICU

“We were blessed to have

a nurse so personable,

attentive, knowledgeable and

supportive, it was as if she was

part of our family.”

Wendy Stewart, RN

Acute Burn Clinic

“Wendy was a godsend…

She insisted on coming in

Saturday AND Monday of

the holiday weekend — she

said ‘this is not about me’…

over and over. She made it

clear my husband was her

primary concern.”

Andrea Daam, RN

GSU

“Andrea came up with a

plan to help get my mother

out of the attitude of ‘being

a patient’ and turn into

being more in control of her

urinary situation…Since that

time, my mother has been

more confident.”

Shannon McBride, BSN, RN

Post Anesthesia Care Unit

(PACU)/Cardiac Surgery

Intensive Care Unit (CSU)

“You have a very special

nurse in Shannon…We

were so scared for him and

Shannon’s explanations

and support provided the

reassurance we needed.”

LEADERSHIP AWARD

personal accountability, coaching, coordination of care, flexibility, promoting a healthy work environment, loyalty, mentoring, professional organization participation, risk taking, shared decision making, and team building

RISING STAR AWARD

a novice direct caregiver RN in

practice for less than two years

who exemplifies the transition to

professional nursing

CoMPASSIoN AWARD

advocacy, caring, comfort, empathy,

holism, resiliency, understanding of

patient and family needs

RESPECT AWARD

acknowledgement of patient

autonomy, dignity, partnership and

collaboration with patients, families

and colleagues in care and decisions,

diversity of thought and knowledge,

ethics, forgiveness, honesty, and trust



Celebration of Nursing Excellence2012 Nurses’ Week AwardsTheNurses’Weekcommitteereviewed50nominationsbeforeselectingthisyear’snursing

excellenceawardwinners.Staffisnominatedbytheirpeers,leadershipteamandaward

recipientsarechosenusingawardcriteriaandsupportingstories.

Michelle Smith, BSN, CRRN – Neurovascular

Unit (NVU)…Firstpersontoserveona

committee,getbehindanideaorinitiative

andbeitschampion.Asachargenurseand

preceptorMichellehandlesherselfwithgrace

andpoiseevenunderthemoststressful

conditions

Katie Walsh, BSN, RN – Surgical Intensive

Care Unit (SICU)…Bigheart,adaptsto

changingsituations,quick,efficient,always

keepsthepatientandfamilyforemostinher

mind

Marilyn Bontrager, RN – Cardiology…

Genuinelycaresforherpatients,families

andworkseffortlesslytorelax,consoleand

encourage.“Youareneveralone”ifMarilyn

isyournurse.

Gervine Brown, RN – General Medical Unit

(GMU)…Gervinewasmyangel.Shetookon

theroleofpatientadvocateformymother-

in-lawwhenIcouldnot.

AWARDWINNERS

PRIDE AWARD

affirmation, engagement,

commitment, creativity, innovation,

recognition, role modeling, and role

satisfaction

ExPERTISE AWARD

autonomy, competency, critical

thinking, evidence-based practice,

interdisciplinary collaboration,

peer review, and professional

development

IMPACT AWARD

clinical excellence, cost effectiveness,

efficiency in care delivery, healing

environment, safety

WesternMichiganUniversity

(WMU)SchoolofNursingAlumni

Scholarship

StuartAvenueInnHonors


Kirsten Rasmussen, BSN, RN – Cardiology…Formal

andinformalleader,handson,supportive,does

whateverittakestogetthejobdoneandkeep

thedepartmentfunctioning,activeinprofessional

organization

Joanne Timmer, BSN, RNC – OB/MBU…Embodies

professionalism,clinicalexpert,possessesabilitytosee

wholepictureoftheunitandassesstheneedsofthe

patients,staff,tirelessinherquestforimprovement.

Jennifer Singleton, BSN, RN – Vascular Access

Specialist Team (VAST)…Consistentlydemonstrates

excellenceinnursingpractice,usesevidence-

basedpracticeasaguide,chairofClinicalQuality,

consummateprofessional,collaborateswiththe

interdisciplinaryteamtomakeproductdecisions

Sharyn Schlueter, RN, CNOR – Surgery…TheWMU

SchoolofNursingAlumniAssociationprovided

agenerous$500awardinrecognitionofoneof

ournurseswhoembodiesexemplaryprofessional

performance.Theawardwinner,SharynSchlueter,RN,

CNORwasselectedbytheAlumniAssociationwiththe

assistanceoftheNurses’Weekplanningcommittee.

Kimberlie Bottles, RN – OB/Labor & Delivery


CardiacRehabilitationnursesexemplifyBMH’s

ProfessionalPracticeModelkeycomponents

ofprofessionalnursingpractice,outcomesand

leadershipthroughtheirparticipationinthe

MontanaOutcomesProject.Thesecomponents,

shownonthebasestarmodeldiagram,aretenetsof

relationship-basedcarethatserveasafoundationfor

BMH’s“environmentforexcellence.”Participation

intheMontanaOutcomesProjectreflectsBMH

professionalnurses’specializedknowledge,

expertise,prideandleadership.Theirdesireto

provideoutstandingcaretopatientsbycollaborating

withcardiacrehabilitationprogramsonanational

levelhasdriventheirparticipationintheproject.

exemplary Professional Practice

Professional Practice ModelNursing Practice and outcomes: Cardiac Rehabilitation

UsingMontanaOutcomesdata,Cardiac

Rehabilitationembracedaprocessimprovement

projecttoreducethepercentageofpatientswith

hypertensiongraduatingfromcardiacrehabilitation

atBMH.Interventionsimplementedforthisprocess

improvementprojectincluded:

•Sendingcustomizedlettertoprimarycarephysician

whenapatientishypertensive

•CheckingexistingequipmentatCardiac

Rehabilitationtoensureproperfunctioning

•Reviewingbloodpressureassessmenttechnique

withthestafftoensureconsistency

•Developingaprocessforalertingstaffmembers

whenapatientinthecardiacrehabilitation

programishypertensive

•CreatingaHypertensionAlertFormtonotifynurses

whenapatientishypertensiveformorethantwo

sessions

Thepercentageofpatientswithouthypertensionat

dischargefromCardiacRehabilitationhasincreased

steadilysincethirdquarter2011.Outcomeshave

exceededbothstateandnationalbenchmarkssince

firstquarter2012.


CarrieKotecki,MSN,RNisan

internalandexternalexpertin

emergencypreparedness.She

hasreceivedseveralnational

incidentcommandsystem

certificationsandservesas

acontractedinstructorat

theCenterforDomestic

PreparednessinAnniston,

Ala.KoteckialsoservesaschairpersonoftheBMH

emergencypreparednesscommitteeandexecutive

boardmemberofthefifthdistrictcoalition.Thefifth

districtrepresents17countiesandworkstoguidethe

regionstraining,resourceallocationandgoals.They

alsoconductanannualcommunitydrill.

AnactiveshooterdrillwasheldatBMHonOctober

29,2012.Together,withthecitypolicedepartment,

SWATteam,K-9officer,EMScompaniesandhospital

staff,totalparticipantsinthedrillnumbered150.

Thisdrillwasperformedtoevaluateeducationand

trainingprovidedtohospitalstaffregardinganactive

shooterincident.Thedrillwasahugesuccessand

producedseveralopportunitiesforimprovement:

•Anewcodeisbeingdevelopedforcommunicating

whenanactiveshooterisinthebuilding.

•Newcommunicationmethodsforallinvolvedin

activeshootersituationarebeingevaluated.

•Interactionwithpolicedepartmentpersonnelis

beingevaluated.

•Initiationofaunifiedcommandwithappropriate

personneltobedefined.

Activeshooterawarenesstrainingclasseshavebeen

offeredatBMHforalmosttwoyearswithmore

than1,000employeesattending.Kotecki’sexpertise,

garneredfrom33yearsofexperienceinemergency

preparednessandhercommitmentasaBMH,

communityandnationalleader,representexemplary

professionalpractice.

Care DeliveryEmergency Preparedness at Bronson: Carrie Kotecki, Internal and External Expert


Thenursepractitionerrapidresponseteam(NP-RRT)

conductedastudytodetermineifearlyrecognition

ofsystemicinflammatoryresponsesyndrome(SIRS)

andimplementingearlygoal-directedtherapy

(EGDT)wouldreducemortality,alteroutcomes.A

databasewasusedtoidentifypatientswhohadtwo

ormoreSIRScriteria(fever,tachycardia,tachypnea,

leukocytosis)aswellasaniongapacidosis.When

criteriaweremet,ittriggeredNP-RRTtoreview

thepatientcaseanddetermineifEGDTshouldbe

initiated.Ifbloodcultures,lacticacidlevel,volume

resuscitationorappropriateantibiotictherapywere

notinplace,theywereorderedordiscussedwith

attending.Outcomemeasuresweretrackedovera

six-monthperiod.


Therewasadecreaseinintensivecareunitadmissions

andanincreaseinpercentageofpatientsreceivingall

fourEGDTcomponents,however,thestudydidnot

showdecreasedmortalityinpatientsseen.

100

90

80

70

60

50

40

30

20

10

0 pre post pre post pre post pre post

Blood Cultures Lactic Acid IV Fluids Antibiotics Drawn Levels

Good

% C

om

pli

an

ce w

ith

EG

DT

Impact of a Nurse Practitioner Rapid Response Team on SIRS Outcomes


Interdisciplinary CareInterdisciplinary Collaboration within the Community

InJanuary2012,incollaborationwithhospitalsinthearea,skillednursingfacilities,andotherpost-acutecare

providers,BMHCaseManagementhostedseveralmeetingstoidentifycomponentsofcommunicationthat

areimportanttoensureasafetransitionfromsettingtosetting.Post-acutecareproviderscametoconsensus

regardingwhatelementsofapatientmedicalrecordwereimportantforthemtoprovideseamlesscare.All

participantsagreedtoincorporatethekeyelementsagreeduponintotheirtransferprocesssoconsistent,

reliablepatientinformationwouldbesharedatthepointoftransfer.BMH’spatienttransferenvelopehasthe

keypointslistedinachecklist-styleformat.

Hospital Acquired Pressure UlcersBMHoutperformedtheNationalDatabaseof

NursingQualityIndicators(NDNQI)meaninseven

outofeightquarters.

Central Line Associated Blood Stream InfectionsBMHoutperformedtheNDNQImeanineightoutof

eightquarters.

1Q11 2Q11 3Q11 4Q11 1Q12 2Q12 3Q12 4Q12BMH 3.11 1.02 2.17 1.67 3.49 0.00 0.00 0.66NDNQI Mean 3.74 3.37 3.04 3.13 2.99 2.88 2.63 2.99

% of Surveyed Patients with HAPU

Good

4.00

3.50

3.00

2.50

2.00

1.50

1.00

0.50

0.00 1Q11 2Q11 3Q11 4Q11 1Q12 2Q12 3Q12 4Q12BMH 0.00 0.24 0.32 0.00 0.00 1.19 0.21 0.63NDNQI Mean 1.47 1.07 1.19 1.33 1.15 2.16 1.00 0.94

CLABSI per 1000 Patient Days

Good

2.50

2.00

1.50

1.00

0.50

0.00

Culture of SafetyBronsonnursesarecommittedtoprovidingthehighestlevelofcareavailabletotheirpatients.Thisis

demonstratedbythenursingteam’sconsistentabilitytooutperformnationalbenchmarks.


Medication Errors That Reach the Patient Specimen Errors


Quality of Care Monitoring and Improvement

BMHexceededthePressGaney

databasebenchmark(topbox

score,%“always”)foreducation

ineightofeightquarters(100%).

Thequestionpatientsareasked

is,“Duringthishospitalstay,did

nursesexplainthingsinawayyou

couldunderstand?”

6

5

4

3

2

1

0 2011 2012

Good

Rate

per

1,0

00 P

ati

en

t D

ays

•2,049morepatientdays

•78fewermedicationerrors

•15percentreduction

3.50

3.00

2.50

2.00

1.50

1.00

0.50

0.00 2011 2012

Good

Rate

per

1,0

00 P

ati

en

t D

ays

•2,049morepatientdays

•82fewerspecimenerrors

1Q11 2Q11 3Q11 4Q11 1Q12 2Q12 3Q12 4Q12

75.7 76.6 75 75.5 75.7 74.4 76.3 76.6

72 72.5 73.3 74.1 73.9 74.3 74.3 74.6

Nurses Explained Thingsin Way You Could Understand

80

75

70

BMH Inpatient % Always

PG Database % Always

Good

Pre

ss G

an

ey S

core


Peer Review for PublicationsLinda Benson, MS, ACNP-BC, CCRN Journal of Cardiovascular Nursing

Karen Bergman, PhD, RN, CNRN Journal of Neuroscience Nurses

Rita Bush, MSN, RN, CCRN, NE-BC American Association of Colleges of Nursing (AACN) editor review board

Glenn Carlson, MSN, ACNP-BC, CCRN Continuing Education article pilot tester 2011

Carla Cook, BS, RN, CCRN AACN CEU article/test review committee

Rita LaReau, MSN, GNP-BC Geriatric Nursing

Donna Moyer, PhD, RN, PCNS-BC Health Behavior and Education, Journal of the American Psychiatric Nurses Association, and abstracts for American Nurses Credentialing Center (ANCC)

Rosemarie Nedeau-Cayo, MSN, RN-BC Beta tester for the Nursing Professional Development Certification Exam through ANCC

Leadership Roles and Committee ParticipationName Professional Organization Position/Involvement

Ann Brissette, BSN, RN Michigan Home Health Association (MHHA) Nominating Committee

Carla Cook, BS, RN, CCRN AACN Ambassador, Continuing Education Review Panel

Judith Cronin, BSN, RNC Association of Women’s Health, Obstetric Conference Planning 2011 and Neonatal Nurses (AWHONN)

Monica Dow-Hepner, BSN, RNC-MNN Southwestern Michigan Perinatal Vice President, Conference Chair and Co-chair Association (SWMPA)

Ashley Foster, BSN, RN Michigan Council of Nurse Practitioners Annual Conference – Exercise Program Chair

Gloria Lowrance, BSN, CNOR Association of Perioperative Registered AORN Board Nurses (AORN)

Julie Martz, RN Michigan Society of Cardiovascular and MSCVPR Outcomes Committee Pulmonary Rehabilitation (MSCVPR)

Donna Moyer, PhD, RN, PCNS-BC Sigma Theta Tau International Honor Research Committee Society of Nursing (STTI)

Rosemarie Nedeau-Cayo, MSN, RN-BC STTI President Upsilon Epsilon Chapter 2009-2011

Lori Reasner, RN, CNOR AORN Nominating Committee

Julie Switek, MSN, RN Upsilon Epsilon Chapter for STTI Secretary

Natasha Watson, MSN, RN-BC STTI Scholarship Review

Julia Wilson, BSN Association for Vascular Access Poster Presentation Judge


ResearchResearchisanexplorationfornewknowledge.AtBronson,nursesarecommittedtogeneratingnew

knowledgeandexploringbestpractices.

new Knowledge, innovation and improvements

Investigator Study Title Department

MargaretMalnight,MSN,RN 2012VermontOxfordNetworkSeriesDaysAudits NeonatalIntensiveCare Unit(NICU)

KarenBergman,PhD,RN,CNRN TheAssociationBetweenAgeandDischarge ProfessionalPractice DestinationforPersonswithTraumaticBrain InjuryfromFalls

ShannonSeeberger,BSN,RN-BC AssessingtheHealthLiteracyofSelf-Identified AdultMedicalUnit CaregiversintheInpatientSetting (AMU)

SheriVandenBerg,RN TheGrayingoftheTraumaPopulation TraumaServicesPaulBlostein,MDScottDavidson,MD

MarsheRemynse,MSN,FNP-BC TheMichiganCriticalCongenital Women’sServices HeartDiseaseNewbornScreeningProgram: StatewideImplementationofBestPractices

Nursing Research 2012ThefollowingnursingresearchprojectswereinitiatedatBronsonin2012:

Name Unit Topic

PattiRohloff,RN CardiacCathLab Whatarethebarrierstobedsidehandoverfrom thenurses’perspective?

TiffanySteffel,RN Pediatrics Whatarethebenefitsofatherapeuticbead programinchildrenwithcancer?

KeriWiersma,RN PediatricIntensiveCareUnit(PICU) Areinsulinpenssaferandmoreefficaciousthan insulinvials?

Evidence-Based Practice ProjectsThefollowingevidence-basedpracticeprojectswereinitiatedatBronsonin2012:



Presentations and PublicationsNursesatBronsonarepassionateaboutsharingtheknowledgeweobtain.Podium/posterpresentationsand

manuscriptsubmissionforpublicationarewaysnewknowledgecanbeshared.

2012 Presentations

Boysen,A.(September,2012).Gestationaldiabetes.Podium.SouthwestMichiganDieteticAssociation,

Kalamazoo,Mich.

Garrod,L.(October,2012).6000Catheter-freedays:CreatingaCultureofZeroInfections.Associationfor

VascularAccessAnnualScientificMeeting.SanAntonio,Texas.

Kubiak,L.(October,2012).UseofhumanmilkinNICU.Podium.WesternMichiganUniversity,Kalamazoo,Mich.

Laughlin,D.Nedeau-Cayo,R.&Rus,L.(October,2012).AssessmentofItemWritingFlawsinMultipleChoice

Questions.Poster.39thAnnualNationalConferenceProfessionalNursingEducationandDevelopment:

NurseEducatorsonaJourneyofExcellence.Philadelphia,PA.

Lechota,J.(May,2012).Whatabloodymess!Massivetransfusionsintrauma.Podium.MichiganEmergency

NursesAssociation.MountPleasant,Mich.

VanderSlik,A.(June,2012).DesignandImplementationofaWebApplicationforReal-TimeDisplayofHand

HygienePerformanceData.Poster.AssociationsforProfessionsinInfectionControlandEpidemiology:

APIC.SanAntonio,Texas.

Zinsmaster,J.,Zoeller,L.&Vliem,S.(April,2012).Highfidelitysimulationinnursingeducation.Poster.Midwest

NursingResearchSociety.Dearborn,Mich.

2012 Publications

Bergman,K.,Kindler,D.&Pfau,L.(2012).Assessmentofstroke:AreviewofEDnurses.Journal of Emergency

Nursing,38,36-42.

Laughlin,D.(2012).Themidlifelearner.Journal for Nurses in Staff Development,28,228-242.



InnovationInnovationisacornerstoneofimprovement.ForwardthinkingBronsonnursesseekuniqueandcreativeways

toaddresstheneedsofourpatients.

Mothers’ Milk Bank and BarcodingCindyDuff,BSN,RNC,IBCLC,foundedBronson

MethodistHospital(BMH)Mothers’MilkBankin

2006,theonlyHumanMilkBankingAssociationof

NorthAmerica(HMBANA)milkbankinMichigan.

BMH’sMothers’MilkBankiscurrentlyoneofonly11

HMBANAmilkbanksintheUnitedStates.Thereare

twoHMBANAmilkbanksinCanada.BMHMothers’

MilkBankcurrentlysuppliespasteurizeddonor

milkto17hospitalsinMichiganand10hospitals

outsideofMichigan.Since2006,morethanahalf

million(511,039)ouncesofhumanmilkhavebeen

dispensed.

Researchshowshumanmilkhelpssickandpremature

babieshavebetteroutcomes.TheBronsonMothers’

MilkBankprovidesthebestnutritiontoinfants

intheNeonatalIntensiveCareUnit(NICU)whose

motherscannotprovidebreastmilk.In2003,74

percentofinfantsdeliveredat32weeksgestation

orless,orwhoweighed1500gramsorless,received

breastmilk.Thepercentageincreasedandhasbeen

maintainedat99percentsince2007afterthemilk

bankwasestablished.

Duetothedramaticincreaseinmilkorders,BMH

Mothers’MilkBankwillexpandin2013.This

expansionwillincludeanewbarcodingprocess

andpreparationofindividualfeedingsforNICU

infants.Thebarcodingsystemwilltrackandtrace

thehandlingandfeedingofbreastmilk,donor

humanmilkandinfantformula.Thisprocesswill

helppreventfeedingerrors.Centralizedhandling

ofhumanmilkisanimportantstrategytoprovide

optimalqualitycaretopatientsbyassuringsafe

storage,preparationanddistributionofhumanmilk

forhospitalizedinfants.

Ounces Dispensed from the Milk Bank

160,000

140,000

120,000

100,000

80,000

60,000

40,000

20,000

0

2006 2007 2008 2009 2010 2011 2012



CardioPat: Decrease Blood Transfusions Eliminatingunnecessarybloodtransfusionsin

thecardiacsurgicalpatientiscritical,asevidence

indicatesanassociationbetweentransfusingred

bloodcells(RBCs)andadverseoutcomesincluding:

resourceutilization,morbidity,mortalityandquality

oflife.ThisevidencepromptedNursing,Perfusion

andcardiacsurgeonswithintheOpenHeart

PerformanceImprovementCommitteetobegin

exploringtacticstodecreasebloodtransfusionsin

late2010.

CardioPatwasidentifiedasastrategythatcouldhelp

decreasebloodtransfusions.Thedeviceisafully-

automatedcardiovascularperioperativeautomatic

transfusionsystemthatcollects,washesandreturns

thepatient’sbloodduringandaftercardiacsurgery.

CardioPatissetupintheoperatingroom,but

reinfusionofthepatient’sbloodoccursinthecardiac

surgeryintensivecareunit(CSU)bynursingstaff.

ThismakessuccessofCardioPathighlydependenton

nursing’sadoptionofthesystembecauseitcreates

extraworkduringacriticaltimeintheopenheart

patient’spostoperativephase.

SinceimplementingCardioPatinlateApril2011,

bloodtransfusionsduringopenheartsurgeryhave

decreasedsignificantly.Thisreductionhaspositioned

BMHfarbelowtheSocietyforThoracicSurgeons

(STS)data.TheSTSisacomparativegrouputilized

forbestpracticesincardiacsurgeriesforpercentage

ofbloodproductsutilizedincoronaryarterybypass

graft(CABG)patients.BMHalsohasthelowestblood

utilizationrateinMichiganwhencomparedtothe

MichiganSTSdatafor2011and2012.

30

25

20

15

10

5

0 Jan 2010 – April 2011 May 2011 – Dec 2012 Pre-Data Post-Data

Good

% o

f Pati

en

ts

Percentage of CABG Patients (without valve replacement) who Receive Blood Transfusions

27.7% 14.6%


Nurse NavigatorThenursenavigatorserviceatBronsonoffersasingle

pointofcontactforpatientsandfamiliesasthey

beginthejourneytomanagecertaindiagnosesand

treatmentmodalities.Anursenavigatormaintains

theroleofeducator,coordinator,facilitatorand

advocate.Anursenavigator’sprimaryobjectiveisto

improvethepatient’squalityandcontinuityofcare

byremovingbarriersandbridginggapsinservice.

Thisensurespatientsreceivecoordinatedcare.

Thenursenavigatorsupportspatientsandfamilies

by:

•Workingwiththemtounderstanddiagnosisand

treatmentoptions

•Helpingthemgaintimelyaccesstoappointments

andresources

•Coordinatingappointmentswithphysicians’and

surgeons’offices

•Offeringeducationandsupportbeforeandafter

surgery

•Findingsolutionstopersonalneedsandconcerns,

suchastransportation,finances,cosmeticservices,

nutritionandgeneticcounseling

•Helpingconnectpatientsandfamilieswith

doctors,outpatienttreatmentfacilities

andothercommunityresources

innovation and improvements

Norm Anderson

Asaretiredsurgicalnurse,BevAnderson

knewthatthetreatmentforherhusband

Norman’scoloncancerwouldinvolvemany

differentdoctors.Whatshedidn’texpectwas

fast,seamlesscommunicationandreferrals

amongallthecareproviders—coordinatedby

Bronson’sOncologyNurseNavigatorService.

Pride

Pati

ent C

are

Del

iver

yProfessional

Nursing Practice

Resource

Driven PracticeCaring &

Healing

Environment

Ou

tcomes

Expertise

Leadership

Resp

ect

Compassion Patient& FamilyPatient& FamilyCo

mmun

ity Team

Self

Bronson Methodist HospitalProfessional Practice Model

celebrating nursing - bronson health

Documents