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24 SEVEN 365University of Iowa Hospitals and Clinics Nursing Services and Patient Care Fiscal Year 2011 Annual Report

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Fiscal year 2011 was an incredible year for University of Iowa Health Care, and our nursing team was right there on the frontlines 24/7/365 to help make it a huge success.

The importance of nurses to our mission was readily apparent when, during the late summer of 2010, our patient census surged, challenging our ability to meet the ongoing staffing demands of caring for almost 100 more patients per day. Our entire hospital team worked together, declaring a Hospital Incident Command System emergency and methodically increasing our staffing levels to where they needed to be. We were energized by this opportunity and, by the end of the year, had grown our ranks by more than 200—many of them educated right here at our own UI College of Nursing. Many were new graduate nurses who participated in our Nurse Residency Program—one for which we’ll work to earn accreditation in 2012 and of which we’re very proud.

The year was full of accomplishments in the areas of patient safety, quality, service, and satisfaction, with nurses helping to lead the way toward new levels of exceptional performance.

In this report, you’ll learn about the Iowa Experience, Excellence Every Time, as well as the ability of our nurses to “wow” their patients by paying attention to important milestones like a high school prom. You’ll also learn about our blood management initiative and ongoing investments in other patient safety practices like bedside handoffs and hourly rounding. We’ll also note our incredible improvements in pressure ulcer and restraint prevalence—areas where we’re making amazing progress due to the commitment of our fantastic nursing team.

We’ve worked hard to recognize and reward those who truly excel through DAISY Awards, Good Catch Awards, and the annual “100 Great Iowa Nurses” nominations. This year, we awarded the first-ever Sally Mathis Hartwig Scholarship and unveiled our revised Professional Practice Model, developed through our shared governance structure.

Our nurses gave back to their communities through a strong showing in this year’s Heart Walk, which raised more than $110,000, as well as donations to other charities. A substantial number of our staff provided relief work after the earthquake in Haiti and in support of other international causes. While back at home, our commitment to Evidence-Based Practice took a new spin with our Sacred Cows initiative. In the year ahead, we’ll be putting sacred cows out to pasture at UI Hospitals and Clinics through the strong work of our Research and Evidence-Based Practice (EBP) committee.

I could go on and on about the characteristics and accomplishments of our nursing team who are here for our patients, families, and each other 24/7/365. We’re the heart and soul of this great organization and we appreciate the opportunity to reflect on what we’ve done and share where we’re going in the years ahead.

Congratulations on another great year from an outstanding nursing team!

Ann Williamson, PhD, RN, NEA-BCAssociate Vice President for Nursing, University of Iowa Health CareChief Nursing Officer, University of Iowa Hospitals and Clinics

CNO Ann Williamson has coffee regularly with nurses to learn from the front lines.

Cover: Kelli Habel, RN, scrubs in the Main OR. The Perioperative Services Division includes 30 ORs open 24/7serving adult and pediatric surgical specialties.

July 2010

100 Great Iowa NursesTen UI Hospitals and Clinics nurses named 100 Great Iowa Nurses, bringing the number of our nurses who have received this recognition to 81 since 2005. Sharon Baumler, MSN, RN, CORLN, OCN, Radiation Oncology; Adella Boeding, MSN, RN, MSM, CCRN, CEN, Emergency Department; Deborah Bohlken, BSN, RN, OCN, Medical-Surgical Services; Laura Cullen, MA, RN, FAAN, Research and EBP; Janie Knipper, MA, RN, AE-C, FAACVPR, Pulmonary Rehabilitation Program; Diane Lamb, BSN, RN, CEN, Emergency Department/Air Care; Michele Lilienthal, MA, RN, CEN, Trauma/Burn; Grace Matthews, MSN, RN-BC, Medical-Surgical Services; Sharon Olson-Comer, BSN, RN, CCRN, C-NPT, Neonatal/Pediatric Transport Team; Mary Jeanne Perino Phillips, MA, RN, Gastroenterology/Hepatology Clinic; Ann Williamson, PhD, RN, NEA-BC, Associate Vice President for Nursing, UI Health Care, and CNO, UI Hospitals and Clinics; Clark Willoughby, BSN, RN, PCCN, Burn Treatment Center

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August 2010 September 2010 November 2010

Iowa Governor’s Lifesaving Award

Nursing Excellence in Clinical Education AwardsAnn Ghabel, MSN, RN-BC, and Christine Berte-Vitzthum, RN, (Staff Nurse) and Deb Bohlken , BSN, RN, OCN (Nurse Leader) received the 2010 education awards.

HICS–High Census ChallengeThe Hospital Incident Command System, or HICS, was adopted in 2009 to serve as an emergency operations plan for responding to disasters and other emergencies. On August 9, 2010, in response to a sustained high census, HICS was activated. In this case, HICS enabled greater attention to and control over significant operational issues by:

Allowing the nursing department to bring people into the organization more quickly. For example, within HICS, a background check can be completed in less than 72 hours.

Implementing a dynamic evaluation process through the After Action Report that is completed after a HICS has ended to identify strengths and weaknesses.

During the HICS, the census was spiking well over 600—averaging 13 percent more patients, and swinging upto 60 percent on some adult units. The extra shift premium was increased and a number of traveling nurses were brought in to some units short-term to support exhausted staff members. The HICS was de-activated on November 8, 2010, after more than 130 nurses were hired, therefore stabilizing patient care operations. 1030

JULIANA DEWILD MAKES HER MORNING ROUNDS THROUGHOUT THE PEDS UNITS. ROUTINE CONTACT INCREASES PATIENT AND FAMILY SATISFACTION.

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Steve Schultz, RN, staff nurse in the Emergency Department, received the Iowa Governor’s Lifesaving Award for responding to an emergency when he encountered four young men tossed into the cold Iowa River when their boat overturned. As the sky darkened, Schultz pulled the men from the water, called 911, and raced to a nearby road, powering his boat through a flooded cornfield to reach the emergency crew.

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ALDIJANA AVDIC PRACTICES BLOOD MANAGEMENT PROCEDURES BY IDENTIFYING THE PATIENT, BLOOD PRODUCT, DOSE, TIME AND INDICATION.

January 2011 February 2011

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BLOOD MANAGEMENT INITIATIVE The University of Iowa Hospitals and Clinics Blood Management Initiative is an evidence-based, multi-disciplinary program designed to promote the optimal use of blood and blood products throughout the hospital. Through education and support, the initiative helps health care team members achieve the best patient outcomes by:

• Early identification and treatment of pre-operative anemia• Awareness of latest evidence-based guidelines on utilization of blood products• Reduction of iatrogenic blood loss• Education on transfusion safety

The Daisy AwardOne of our Daisy Award winners, Brenda Walker-Connell, RN, received high praise from a patient’s daughter. “Ms. Walker-Connell demonstrated exceptional clinical skills and a compassionate, patient-centered approach in her care for my father during a recent appointment at the Cancer Center. His oncologist reviewed his lab work, gave him a brief exam, and said that his labs were fine and directed us to the infusion area to receive his medication. In the infusion area, prior to giving him the medication, Ms. Walker-Connell also reviewed the day’s lab results and noted a very low potassium value. She then carefully checked his vitals noting an irregular heart beat and low pulse. Ms. Walker-Connell’s integrity and willingness to contact my father’s physician with her concerns led to further evaluation of his cardiac status and potassium supplementation. I am certain that because of Ms. Walker-Connell’s excellent nursing care, a potential health crisis for my father was averted.“

Sacred CowSacred Cow Rustlers search for routine practices that are resistant to change, and send them out to pasture

Focus on the Foley“Focus on the Foley” campaign to reduce catheter-associated urinary tract infection

THE DAISY AWARD IS A NATIONAL PROGRAM THAT RECOGNIZES AND CELEBRATES EXTRAORDINARY CLINICAL SKILL AND COMPASSIONATE CARE GIVEN BY BEDSIDE NURSES. AT UI HOSPITALS AND CLINICS, A DAISY AWARD IS GIVEN EACH MONTH.

Daisy Award Winners July 1, 2010 to June 30, 2011July 2010 - Shawna Holbrook, RNAugust 2010 - Amanda Van Weeldon, RNSeptember 2010 - Jim Cornwell, RNOctober 2010 - Tyanna Gruenwald, BSN, RNOctober 2010 – Rebecca Medhurst, BSN, RN

November 2010 – Carol McCafferty, BSN, RNDecember 2010 – Tina Pacha RN-BCJanuary 2011 – Heidi Bernard, RNFebruary 2011 – Tamika Miller, BSN, RNMarch 2011 – Stephanie Cummings, BSN, RN

April 2011 – Brenda Walker-Connell, RNMay 2011 – Jerri Karr, RNJune 2011 – Melissa Kiger, BSN, RN

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GOOD CATCH AWARD—RECOGNIZING SAFETY A near miss is an event or situation that could have resulted in an accident, injury, or illness, but did not, either by chance or through timely intervention. Recognizing potential problems is a “good catch.” It allows for corrective action before an event is experienced by a patient, staff, or visitor.

March 2011

Julie Liebe, RN, Perioperative DivisionA patient who was scheduled for a left sided craniotomy entered the operating room with her head appropriately marked. The patient was prepared and positioned for surgery and the incision site was marked. When Julie began to apply the betadine prep, she noted that the location of the surgeon’s initials, which are placed as part of the correct operative site preparation, were out of the normal range. She stopped and questioned the side. The patient had been positioned and the right (incorrect) side was exposed and being prepped instead of the left (correct) side. Julie notified the resident immediately. The patient was repositioned and correct side prepped. A wrong side surgery was prevented.

Jennifer Beschorner, BSN, RN, 6RCW “After participating in educational sessions on blood safety and management, Jennifer questioned a physician order for three units of PRBC for her patient who was not actively bleeding. She also recognized that the patient was iron

deficient. Jennifer brought this to the attention of her nurse manager who contacted Anne Smith, MSN, RN-BC. who oversees blood and blood product quality issues. With some guidance, Jennifer

approached the resident and questioned the order. Because of her actions, the patient was given one unit of blood instead of three and was started on iron.”

Certified Nurses Day was March 19. We have more than 375 certified nurses to date.

CNO Ann Williamson, PhD, RN, NEA-BC, and Professor Jane Paulsen, PhD, were named 2011 Women of Influence by the Corridor Business Journal.

1300SAFE PATIENT HANDLING HAS BEEN A PRIORITY IN THE NURSING DEPARTMENT SINCE 2002. SINCE THEN, STAFF INJURY COSTS HAVE GONE DOWN FROM $703,000 IN 2002 TO $294,000 IN 2011.

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Nurses from 7RCS, along with Richard LeBlond, MD, Chief Quality Officer at UI Hospitals and Clinics, celebrate the unit’s success in reducing pressure ulcers through the STAR (Skin Team Advocate and Resource) effort. Throughout fiscal year 2011, hospital-acquired pressure ulcer (HAPU) incidents steadily declined. The HAPU rate across the hospital at the beginning of the fiscal year (July 2010) stood at 6.5 percent; by the end of June 2011, the rate was less than 4 percent.

May 2011April 2011

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WITH A FOCUS ON HAND-OFF COMMUNICATION, NURSES RIHANA AL-GHALAYINI AND ANDREA EICHLER KEEP PATIENT SAFETY A TOP PRIORITY.

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UI nurses, along with other hospital staff, volunteers, and students with UI Dance Marathon, helped make prom a reality for one Iowa girl with leukemia. Brittany Bettag, 17, of Maquoketa, Iowa, had been hospitalized since mid-March after being diagnosed with the disease. But thanks to the efforts of nurses and others, a special prom was organized in the hospital’s recreational therapies gym so that Brittany could experience the pageantry and excitement. The gym was decorated and packed with other prom-goers, including fellow pediatric patients. Brittany’s boyfriend, UI freshman Jonathan Sneddon, escorted her down a special red carpet. It was an event to remember—and just one example of how nurses go the extra step for a patient’s overall care and well-being. For Brittany, her prom was more than just the next best thing.

“It wasawesome,”

she said.

UI Hospitals and Clinics leads the nation in transfusion safety related to bar code scanning procedures.

UI Hospitals and Clinics awarded the Silver Medal of Honor by the federal Health Resources and Services Administration for surpassing national goals for organ donation

Awarded designation as a NICHE hospital – Nurses Improving Care for Healthsystem Elders

Nursing leads the way for the “Start! Heart Walk” sponsored by the American Heart Association.1530

49%

23% 26%

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Restrain use in UIHC critical care units declines from 49 percent to 4 percent in FY11 due to focused efforts.

NDNQI benchmark mean

Q1 Q2 Q3 Q4

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PROFESSIONAL NURSINGPRACTICE MODEL The Professional Practice Model is a visual representation of the values, organizational structures, and processes that provide a unifying framework for the practice of nursing at UI Hospitals and Clinics. It ensures consistency in the delivery of nursing care, and defines for all registered nurses their authority, autonomy, and accountability as they care for patients and families.

SALLY MATHIS AWARD Last year, one of our former nursing directors, Sally Mathis Hartwig, pledged $50,000 to the UI Foundation to support scholarships for our nursing staff attending the UI College of Nursing. This year’s graduate student recipient recipient was Melissa Gross, BSN, RN, CNRN.

2200 NURSE JULIANA DEWILD DISCUSSES PEDIATRIC PATIENT KILEY DIDESCH WITH HIS PARENTS AND DR. MINA KIM WHILE DRS. SARAH HASKELL AND MICHELLE KOMPARE REVIEW NOTES WITH KRISTEN BROWN, ARNP.

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Safe, High-Quality Patient and Family-Centered Care

June 2011S.T.A.R. Performance

MAY 2011Hospital Prom

June 2011

Our service excellence program, “The Iowa Experience—Excellence Every Time,” has been a great success. More than 4,500 faculty and staff have been trained in service initiatives such as “The Iowa Greeting” and the “Heart Model” for service recovery. We are focusing on our shared purpose, “Caring with our minds, hands, and heart” for every patient, at every encounter, every time, and have implemented the Service Star Award for staff caught in the act of performing outstanding service excellence. Most importantly, we are seeing results.

For Melody Webster, MSN, RN, a staff nurse in the Medical Intensive Care Unit, international medical relief work is not about career development or “adventure.” It’s about “helping people who desperately need help,” she says. Webster has made her global interests a reality, with medical service trips to several Latin American nations in recent years—including three trips to Haiti since a 2010 earthquake devastated the nation. Webster credits her nurse managers and colleagues for allowing her to adjust her schedule, covering for her, and even donating vacation time as needed. Webster, in turn, serves as an information resource for other UI nurses interested in participating in global relief efforts—and indeed, a number of nursing staff members have traveled to other nations to get involved in medical mission work. It’s a reflection of our nurses not just as professionals, but as people.

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Claire Harapat, RN, is a NICU nurse who was driven to nursing because of the way NICU nurses took care of her own baby years earlier. She says, “the NICU nurses were my lifeline.” Harapat is committed to making a difference—to give back to other families what nurses had given to hers.

CLAIRE HARAPAT NICU NURSE

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