WakeMed Nursing2 0 1 8 A N N u A l r e P o r t

We Are Proud.

Welcome to the 2018 WakeMed Nursing Annual Report. In addition tosharing some of Nursing’s highlights from the past year, we would like totake this opportunity to unveil the updated Magnet campaign logo. Wehave changed the slogan from “I Am Proud.” to “We Are Proud.” toreflect the pride we as a community of caregivers take in workingcollaboratively to achieve the best possible outcomes for our patients.

Our new logo is one of the ways we are preparing for our Magnet re-designation visit. Magnet recognition is a voluntary accreditation thatprovides a blueprint for excellence, improving work environments,reductions in patient harm and best practices for patient safety. (Aiken,2018) The three years since our initial visit with the Magnet apPRAISErshave flown by! Our Magnet document is due to the American NursesCredentialing Center by August 1, 2019, and, once that is accepted, wecan anticipate our site visit in late 2019 or early 2020.

We Are Proud.

Cindy Boily, MSN, RN, NEA-BCSenior Vice President & Chief Nursing Officer

WakeMed Health & Hospitals

It has been an extremely busy year for WakeMed nurses – lots ofresearch, innovation and analysis to improve the quality of care andexperience for our patients and their families. Also in this report, you’llsee the extensive list of publications and presentations where WakeMed

nurses have been selected to share theirresearch and practice innovations. Thesecontributions to new knowledge influence stateand national work environments whileadvancing clinical outcomes.

What makes you special is the way you areguided by the WakeMed Nursing ProfessionalPractice Model in all that you do. Your‘Compassion’ is real, your patient ‘Advocacy’ isheard loud and clear, you’re building trusting

‘Relationships’, and your nursing ‘Excellence’ and attention to patient‘Safety’ are evident as you continuously Chase Zero.

Please enjoy the following report, which includes just a few of the pastyear’s many accomplishments. YOU make all the difference for ourpatients – it makes me so proud to be a WakeMed nurse. Thank you forbeing amazing.

From our Senior Vice President & CNo

We Are Proud. From our President & Ceo

Donald R. GintzigPresident & CEO

WakeMed Health & Hospitals

The ability to respond with both expertise and compassion to the unique needs of eachpatient takes a tremendous amount of versatility and adaptability. You may not evenrealize it because, as a nurse, it’s just a part of who you are. But it is a very specialability – one that is particularly visible in times of crisis.

Ice storms and hurricanes put the WakeMed family into overdrivethis past year. Your role as nurses and your special ability to adaptto any situation are critical when a crisis strikes our community,and I am so appreciative of the way you rise to the occasion. Yousupport your patients, coworkers and even those simply seekingshelter from the storm at our hospitals and healthplexes. Youwork longer-than-expected hours to ensure your department hasadequate coverage. And you do your best to maintain a calm,healing environment even though there are torrential rains,

power outages and other adverse conditions outside our doors.

As you weathered the storms, you also helped WakeMed weather several JointCommission surveys, surveys from other accrediting organizations and the occasionalhealth department visit. It’s likely that more nurses were involved in these events thanany other member of the WakeMed family. You play a pivotal role in the success andoverall well-being of our health system and our community at large. No matter thechallenge, you let the top of the Pyramid – our patients and families – be your guidinglight and you continue to make a difference in the lives you touch each day.

Thank you for being exceptional people, providing exceptional care.

We Are Proud.

Heather Hopkins, BSN, RN, CCRN, EMT

CNC Leader

Jason Wilson, RNCNC Leader

From our Clinical Nurse Council leaders

How do we know if a new protocol is working for our patients? Bysetting goals, benchmarking against best practices and trackingpatient progress and outcomes. We applied this same approach to

leading our ClinicalNurse Council (CNC)this past year and indoing so, gainedimportant perspectiveabout CNC membersand all WakeMednurses.

Our goals focused onthe professional

development of CNC members. Our desired outcomes includedincreasing the number of their certifications, increasing theparticipation in the course on shared decision-making and sharingunit-based expertise through 50 nursing poster presentations.

The fact that CNC members worked to achieve those goals reflectstheir engagement and commitment to continuing to provideexcellent care for our patients and families. In addition, it means we are all working to make WakeMed the best place to practicenursing. Thank you for the opportunity to lead such a great team!

We Are Proud.

First in the u.S. to Implement erAS® for Heart Surgery

What began as a goal for a solitary nurse became aninterprofessional success of national importance.WakeMed is the first hospital in the United States tointroduce early recovery after surgery (ERAS) for heartsurgery patients – a value-based, single, standardizedpathway approach to surgery. Gina McConnell, BSN, RN,CCRN, WakeMed Cardiothoracic Intensive Care, and herphysician partner heart surgeon Judson Williams, MD,have been sharing their expertise and results of theirefforts at conferences throughout the United States.

The team’s work was also the cover storyfor the magazine Nursing 2018.McConnell and Williams, along withPatricia Woltz, PhD, RN, William Bradford,MD, and Erin Ledford, PharmD, authoredthe article which is titled “Rationale,design and implementation of anenhanced recovery after cardiac surgery(ERAS-Cardiac) program to improvehealthcare quality.”

Unadjusted Clinical Outcomes on First 9 Months of ERAS® Cardiac Program Compared to Previous Months

POSTOP GI COMP- ICU INTUBATION REINTUBATION LICATIONS TOTAL ICU READMIT POSTOP TOTAL TIME RATE RATE STAY RATE LOS LOS (MEDIAN HOURS) (%) (MEDIAN HOURS) (%) (MEDIAN DAYS) (MEDIAN DAYS)

PRE-ERASCardiac 5.3 5.3 6.8 43.0 5.3 7.0 9.0(N=489)

ERASCardiac 5.4 4.3 3.8 28.0 3.8 6.0 8.0(N=443)

LOS = Length of Stay

We Are Proud.

Providing the Proper SeND off

SEND Off – Structured Engaged NursingDischarge – the new structured dischargeprocess in 5A Medical Intermediate Care,continues to positively impact patientsatisfaction scores for the unit. A clinicalnurse from the unit brought the basicconcept to WakeMed after learning aboutit at a national nursing conference. The5A Unit Council then adapted the conceptfor their patients. It’s success has made ita standard of practice for the unit. It isalso an important reminder of how simply

sitting and talking with a patient can dramatically impact communication andthe entire care experience.

PRC % Excellent - Patient Satisfaction with Nurses' Communication

FY 2017Q1

(Oct-Dec)

FY 2017Q2

(Jan-Mar)

FY 2017Q3

(Apr-Jun)

FY 2017Q4

(July-Sept)

FY 2018Q1

(Oct-Dec)

FY 2018Q2

(Jan-Mar)

5A Medical Intermediate CareUnit/Raleigh Campus 44.0% 62.3% 62.0% 50.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Perce

ntag

e Exc

elle

nt

PRE -

POST -DATA

INTERVENTIONS

life-saving CPr for Coaches

By its mission, WakeMed is committed to improving the health and well-beingof our community with outstanding and compassionate care to all. WakeMednurses embrace our community-minded mission by educating the public abouthealth care topics and performing screenings throughout the area.

WakeMed Nursing Education is doing their part by coordinating SportFit, anevent to provide Wake County Public School System athletic directors (ADs)and coaches with Heartsaver® CPR and AED training. The program is fullyfunded through the WakeMed Foundation, which means the education is freefor attendees – many of whom are volunteers. Approximately 300 coaches andADs have received this life-saving training since SportFit began in 2017.SportFit also increases the rate of bystander CPR and AED preparedness forthe entire community in keeping with Healthy People 2020 goals.

POWERED BY

P

We Are Proud.

WakeMed began the system-wide Chasing Zero initiative to eliminate allpreventable harm, including Hospital acquired infections (CAUTI, CLABSI, C.difficile, etc.), surgical site infections, falls with injury, preventable sepsis, wrongsite/wrong patient/wrong procedure surgeries, retained objects, medication errors,pressure ulcers and preventable blood clots. WakeMed Cary Hospital received thefirst-ever Chasing Zero Hero award for being CLABSI free for 15 months.

Administrative champions for the Chasing Zero campaign are WakeMed Senior Vice President & CNO Cindy Boily, RN, MSN, and WakeMed Senior Vice President & Chief Quality & Medical Staff Officer, West Paul, MD, PhD.

Com

plia

nce R

ate f

or SE

P-1

0%

25%

50%

75%

100%

CQO Letters

eICU/ICU Collaboration

Performance Emails

Code Sepsis

2017Q2 2017Q3 2017Q4 2018Q1 2018Q2 2018Q3

59% 66% 67% 60% 57% 73%

64% 60% 82% 73% 71% 83%

50% 53% 52% 56%

49% 51% 51% 54%

83% 84% 83% 84%

2016Q1 2016Q2 2016Q3 2016Q4 2017Q1 2017Q2

Raleigh SEP-1 Rate 17% 24% 28% 32% 46% 59%

Cary SEP-1 Rate 10% 33% 20% 35% 45% 64%

NC Average 39% 43% 37% 40% 47% 50%

National Average 40% 44% 40% 44% 47% 49%

National Top 10% 82% 83%

Stopping Sepsis, Saving lives

Treatment guided by the use of evidence-based care bundles from the SurvivingSepsis Campaign guidelines is directlylinked to improved mortality and qualityoutcomes. WakeMed has aninterprofessional team continuallyworking on improving care for ourpatients with sepsis through educationnew screening tools, ordersets andprotocols, metric tracking and monthlycase reviews with feedback.

The eICU, ED and Rounding Nurse Program are instrumental in expediting identification and care of this patient population. 

System SEP-1 Compliance to State and National

“System-wide compliance on the CMSSEP-1 Bundle is now above state andnational averages. More importantly,

we have SAVED 184 LIVES since2016!”– Aranzazu Conklin, BSN, RN,

WakeMed Clinical Nurse Specialist

We Are Proud.

Decreasing Device Days

WakeMed Nursing’s innovation, teaching and leadership have led tocontinued decreases in device days for patients with catheter-associatedurinary tract infections (CAUTIs) and central line-associated bloodstreaminfections (CLABSIs).

CLABSI Reduction Efforts

Nursing’s focus is on care, access andmaintenance of central and arteriallines. The Ultrasound Guided PeripheralIV (UGPIV) training program continuesto improve the IV placement experiencefor patients with difficult venous access.More than 260 nurses throughout thehealth system are certified to use thetechnique. Experienced practitioners ofthis skill consistently achieve greaterthan 90 percent first-stick success in ourmost challenging IV access patients.

Because everyone can benefit from a skills refresher, 2,700 nurses weredirectly observed practicing four central line procedures to ensure competencyof best-practice use during the past year. In addition, care for intensive carepatients with arterial and central lines is now standardized in accordance withupdated best practices.

CAUTI Reduction Efforts

We attribute the decrease in device days to several Nursing initiatives. Duringthe past year, Nursing introduced several alternatives to Foley catheters,resulting in a 16 percent decrease in their use. An interprofessional task forcecontinues to reinforce the importance of proper urine culture practices,reducing unnecessary cultures to determine the necessity of a Foley catheterand its timely removal.

“Preventing a CAUTI has been a teameffort on 2E. We focus on removing

Foleys as soon as possible and weprovide Foley care at 12-hour intervalsas a minimum.” – Kelly Lee, BSN, RN-

BC, 2E Medicine, WakeMed CaryHospital

ClABSI Device Days

FY 2017 2018

Health System 42,521 35,208 PerCeNt DeCreASe 17%

ClABSI Actual Infections

FY 2017 2018

Health System 50 35 PerCeNt DeCreASe 30%

CAutI Device Days

FY 2017 2018

Health System 45,828 35,208 PerCeNt DeCreASe 23%

We Are Proud.

PRISM Award

In 2018 WakeMed’s 6C Surgery & Trauma unit becamethe second unit in the state and the thirtieth in the nationto earn the AMSN PRISM Award®, co-sponsored by theAcademy of Medical-Surgical Nurses (AMSN) and theMedical-Surgical Nursing Certification Board (MSNCB).The team earned the award for their effective leadership,recruitment/retention of competent staff, implementationof best practices, high-quality care, maintaining a healthywork environment and lifelong learning.

From Our Patients & Peers

More than 200 a month – that is howmany DAISY Award nominations arereceived from WakeMed patients andtheir families. The DAISY Award givesthose we care for the opportunity torecognize a nurse or care team for highlycompassionate care and service.

recognizing excellence

Academy of Medical-Surgical Nurses Board Member

WakeMed’s Kristi Reguin-Hartman, MSN, APRN,ACNS-BC, (right) is a new member of the AMSNBoard of Directors.

Recognition for Infection Prevention Efforts

Jessica Dixon, MHA, RN, CIC, FAPIC, WakeMed InfectionPrevention, earned 2018 Great 100 Nurses in NorthCarolina honors. She is known throughout the organizationas a go-to expert for all things infection prevention.

PETALS, which stands for Professional ExtraordinairesThat Always Lend Support, gives nurses, patients,families and other staff members the opportunity torecognize the unit secretaries, medical technologists,therapists, Environmental Services employees and othersupport staff for helping to provide the best care andcare environments. About 200 PETALS Awardnominations are also submitted each month.

“As the program chair and a PETALS Award recipient, I can say that this award program

has long-lasting effects.  To feel noticed andappreciated in what we love to do affirms our call to

patient care.  I am so proud to be a part of a programthat fosters strong bonds among patients, families,

and staff.” – Monica Lineberry, Nurse Aide I/Clinical Secretary, 5C Medicine,

WakeMed Raleigh Campus36% of WakeMed

2018 Pyramid Societywinners are nurses!

We Are Proud.

recognizing excellence

Leading the Way to a National First

Congratulations to WakeMed HeartCenter’s Marian Uy, BSN, RN, andWendy Anderson, BSN, RN. Theirleadership helped WakeMedbecome the first U.S. hospital toreceive the American College ofCardiology’s Version 3 AdvancedHeart Failure Accreditation.

Empowering Nurses

WakeMed SVP & CNO Cindy Boily, MSN, RN,NEA-BC, receivedthe Triangle Business Journal’s Women in Business Award for herwork empowering nurses to advance their careers and providehigh-quality care to our patients.

Statewide Governance

Congratulations to WakeMed’s Becky Ezell,RN, CPN, who was elected to serve on theNorth Carolina Board of Nursing.

Great engagement rate!

We are proud of the increase in overall nursing engagement during the past three years.

Nurses are committed to WakeMed’s success and ratedour organization higher than our Magnet cohorts in six categories.

WakeMed Nursing Engagement Survey Trended Profile

“I love WakeMed because employees are valued. We make a difference!”

Carrie Fraser, RN, CCRNSTICU, WakeMed Raleigh Campus

We Are Proud.

Certifications We exceeded our certification goal for FY 2018.

Degrees We outperform other Magnet hospitals for BSN-or-higher degrees.

Nursing Professional Development Program

The WakeMed Nursing Development Program (NPDP) helps nurses advance theircareers through leadership and quality improvement projects and interprofessionalexperiences. The NPDP Advisory Board reports a 25 percent increase in Level 3 nurses

from 2016 to 2017. To date,NPDP participation increasedby 55 percent since theprogram’s establishment in2015. And, with just shy of1,000 intention-to-participatedocuments to review for2019, the NPDP AdvisoryBoard has a lot to do!

ACTUAL 41.91%

GOAL 40.37%

ACTUAL 69.18%

GOAL 66.49%

Professional Growth ImprovesPatient outcomes

The numbers prove it: WakeMednurses constantly strive to betterthemselves through theopportunities provided to themboth inside and outside the healthsystem.

“As an NPDP committee member, I work with both clinical and non-clinical staff

from across multiple departments to helpguide decisions that have the potential to

affect every bedside nurse within theWakeMed system.” – Donald Lemaire,

BSN, RN, CCRN-CSC, CTICU, WakeMed Raleigh Campus

MAGNET 60.8%

MAGNET 50.33%

Nursing by the Numbers

Nurses: 3,520

Average Years of Service: 7.57

Nursing Turnover Rate: 9.3% – 11%

National Nursing Turnover Rate: 17.7%

Nursing Vacancy Rate: 4.88%

Nurse Fellow Retention Rate after 1 Year: 93%

WakeMed Nursing Executive Council

"Being a new-grad nurse isintimidating. Fortunately, the Nurse

Fellowship program has been with meevery step of the way. I have made new

friends, gained new skills, and mostimportantly, I have learned that I am

not going through this transitionalone." – Meredith Givens,

RN, 3A CVIC

FY18 Regional & National Nursing Presentations & Publications

Poster Presentations

Baker T, Wood S, Rowe T, and the Rounding Team. (2017, Nov). Rounding nurse program:promoting patient safety and nursing satisfaction. Cone Health Nursing Research and EBPSymposium, Greensboro, NC.

Kleeberg L, Russell J, Walker-Jackson D, Woltz P. (2017, Nov). Rest enhancement menu: a nurseaide driven initiative. Cone Health Nursing Research and EBP Symposium, Greensboro, NC.

Kubic M. (2017, Nov). Effectiveness of sterile vs. clean technique on blood culture contaminationrates: a quantitative systematic review. Cone Health Nursing Research and EBP Symposium,Greensboro, NC.

Rawls E, Williams F, Uy M, Anderson W, Moore J, Kubler M, Krizay M, Beavers J, McLean B,Amery S. (2017, Nov) Navigating the course for high risk AMI patients: a team approach. ConeHealth Nursing Research and EBP Symposium, Greensboro, NC.

Phillips A. (2018, Feb). Development of painphilosophy for newly-hired nurses. NACNSNational Conference, Austin, TX.

Elliott J, Reguin-Hartman K, Lockridge-Brown J,Dixon J, Holt S. (2018, Mar). Rounding to reducehospital acquired infections: role of the clinical nursespecialist. NCONL Conference, Greensboro, NC.

Kleeberg L, Turner A, Midgette T. (2018, Mar).Operation don’t let them fall. NCONL Conference,Greensboro, NC.

We Are Proud.

“I was excited to present my first ever evidence-based practice poster. This accomplishment is

due in part to the master’s program I am in, thanks to WakeMedtuition reimbursement. It is also due to great mentoring by PatWoltz, Ph.D. She encourages me to find answers to my clinical

questions and then share my knowledge with others. I feel proud towork and learn along with a committed team!” –

Kelley Reep, BSN, RN, CCRN-CMC, Critical Care/Cardiovascular Care, WakeMed Cary Hospital

McConnell G, Allender J, Woltz P,Bradford W, & Williams J. (2018,Mar). Implementation and earlyoutcomes of an enhanced recoveryafter cardiac surgery (ERAS-Cardiac)program. NCONL Conference,Greensboro, NC.

Moretz J, Woltz P. (2018, Mar).Comparison of noninvasive toinvasive cardiac output monitoring

for developing nurse-driven best practices. NCONL Conference, Greensboro, NC.

Elliott J, Conklin A. (2018, May). An innovative approach to stop the clock, close the loop, and beatsepsis. AACN National Teaching Institute 2018, Boston, MA.

McConnell G, Allender J, Woltz P, Bradford W, Williams J. (2018, May). Implementation and earlyoutcomes of an enhanced recovery after cardiac surgery (ERAS-Cardiac) program. AACN NationalTeaching Institute 2018, Boston, MA.

Moretz J, Woltz P. (2018, May). From evidence to application: non-invasive hemodynamicmonitoring in a cardiothoracic intensive care unit. AACN National Teaching Institute 2018, Boston,MA.

Williams F, Waugaman S, Thompson N, Weeks T. (2018, May). Excellence in chapter leadership:you've got a friend. AACN National Teaching Institute, Boston, MA.

Taylor C. (2018, Jul). The road to bringing creative education ideas to the unit level. ANPD AnnualConvention, Orlando, FL.

McConnell G. (2018, Aug). Implementation and early outcomes of an ERAS-Cardiac program.EBPOM-USA Masters Course: A Perioperative Care Practicum, Chicago, IL.

Davis D. (2018, Sep). Effect of an educational intervention in acute coronary syndrome: aquantitative project. Asian American/Pacific Islander Nurses Association International Conference,Durham, NC.

Lockridge-Brown J. (2018, Sep). Role of the Clinical NurseSpecialist (CNS) in improving the glycemic management inhospitalized patients without diabetes. NCNA AnnualConvention, Concord, NC.

Stillman P. (2018, Sep) SEND-OFF: Structured Engaged NursingDischarge-Off: a grassroots initiative to improve dischargeprocess. 27th Annual AMSN Convention, Orlando, FL.

Howard C. (2018, Oct). Nurse community partnership toimprove domestic violence outcomes. ANCC National MagnetConference, Denver, CO.

Veeder S. (2018, Oct). Get on board: creating an all-access pass tocertification. ANCC National Magnet Conference, Denver, CO.

We Are Proud.

Podium Presentations Deifer S. (2017, Oct). WakeMed eICU services - yoursepsis quarterback. Philips Connect2Care 2017, LosAngeles, CA.

Smith C, Deifer S. (2017, Oct). Time… clock of the heart.National Philips Health Care Conference, Orlando, FL.

Smith C, Deifer S. (2017, Oct). WakeMed eICU serviceskeeps your beans jumping. National Philips Health CareConference, Orlando, FL.

Hicks N, Urton M. (2017, Nov). A fall preventioncollaboration in the emergency department. Cone HealthNursing Research and EBP Symposium, Greensboro, NC.

Farmer J. (2017, Dec). Sexual assault kit collection in theemergency department. 4th Annual Forensic

Investigations Conference, Fayetteville, NC.

Farmer J. (2017, Dec). Forensic photo documentation. 4th Annual Forensic InvestigationsConference, Fayetteville, NC.

Kindl H. (2018, Feb). GPS mentor program. ANPD Cardinal Chapter Affiliate Quarterly Meeting,Burlington, NC.

Klaess C. (2018, Feb). Pain team of one? CNS quest to improve pain management in acute care.NACNS National Conference, Austin, TX.

Bird P. (2018, Mar). Generalist nurses caring for patients with mental illness in a non-psychiatricsetting. NCONL Conference, Greensboro, NC.

Smith C, Deifer S. (2018, Mar). Why eICU C.A.R.E.S. about quality. AACN Annual EducationSummit, Piedmont Carolinas Chapter, Charlotte, NC.

Davis D. (2018, Apr). Improvements in stroke care through community partnerships and bridgingthe gap between hospital units. AHA and ASA Mid-Atlantic Heart and Stroke Quality Summit,Raleigh, NC.

Falk M. (2018, Apr). Evaluating clinical faculty competency across disciplines. 2nd AnnualConsortium for Clinical Education and Practice Conference, Greensboro, NC.

Hammond N, Mirenda F. (2018, May). Lactation across the system. EPIC - XGM 2018, Verona, WI.

Hatch C, O’Neal J. (2018, May). Impacting patient and staff satisfaction with a dedicatedchaplain. Excellence In Healthcare Conference, Charleston, SC.

Taylor C. (2018, May). Bringing creative education ideas to the unit level. ANPD and LippincottWebinar.

Hammond N, Reif S. (2018, Aug). A campfire story on how to save clicks and time using varioustools: optimizing circumcision workflow. EPIC - UGM 2018, Verona, WI.

Miliano V, Phillips L, Gantt A. (2018, Aug). OB ED leveraging stork tools in an emergencydepartment setting. EPIC - UGM 2018, Verona, WI.

McConnell G. (2018, Sep). Enhanced recovery after surgery. EBPOM-USA Masters Course: A Perioperative Care Practicum, Chicago, IL.

Urton M. (2018, Sep). Multimodal pain management: addressing the opioid epidemic at thebedside. ASMN Conference, Orlando, FL.

Piercy B, Penninger J. (2018, Oct). From paper to practice: getting your team on the same page.ANCC National Magnet Conference, Denver, CO.

Publications

Grimes M. (2018, Aug). Ethics: ethical issues with medical errors: shaping a culture of safety inhealthcare [Letter to the Editor]. Online Journal of Issues in Nursing. Retrieved fromhttp://ojin.nursingworld.org/MainMenu Categories/ANAMarketplace/ANAPeriodicals/OJIN/LetterstotheEditor/ Response-by-Grimes-to-Sorrell-Medical-Errors.html.

Klaess C, Jungquist C. (2018). Current ketamine practice: results of the 2016 ASPMN survey onketamine. Pain Management Nursing, 19(3), 222-229.

Reguin-Hartman K, Bush R, Hopkinson S, Murray A, Parmley S, Prue-Owens K, Steinwedel C.(Eds). (2018). Scope and Standards of Medical-Surgical Nursing Practice. (6th ed.). Pitman, NJ:Academy of Medical Surgical Nurses.

Williams F, Scott E, Tyndall D, Swanson M. (2018). New nurse graduate residency mentoring: aretrospective cross-sectional research study. Nursing Economics, 36(3), 121-127.

McConnell G, Woltz P, Bradford W, Ledford E, Williams J. (in press). Rationale, design andimplementation of an enhanced recovery after cardiac surgery (ERAS-Cardiac) program toimprove healthcare quality and value. Nursing 2018.

Stone E. (in press). From the start. In (Eds.), Emergency Nursing Pediatric Course, (5th ed.).Schaumburg, IL: Emergency Nurses Association.

Stone E, Iyer S. (in press). Pediatric quality improvement in the pre-hospital and emergencydepartment worlds: tools and examples to guide change. Clinical Pediatric Emergency Medicine.

We Are Proud.

WakeMed Health & Hospitals • www.wakemed.org

Raleigh Campus • Cary Hospital • North Family Health & Women’s Hospital • Apex Healthplex • Brier Creek Healthplex

Garner Healthplex • Clayton Medical Park • Raleigh Medical Park • WakeMed Outpatient Rehabilitation Facilities

Home Health • WakeMed Physician Practices • Capital City Surgery Center

WakeMed nurses whoshared their expertisewith state and nationalaudiences and inpublications in FY 18.