Mercy Hospital of Buffalo Annual Nursing Report: 2014

Nursing ReportCaring • Compassion • Quality

2013-2014

“Our name is Mercy; our spirit is compassion.” These words from Mother Catherine McAuley, the Foundress of the Sisters of Mercy, who established Mercy Hospital of Buffalo in 1904, best describe who we are as a hospital family. We are a team not only committed to medical excellence but to also providing a caring environment for our patients.

Quality care is often measured through healthcare stats and clinical reviews. Mercy Hospital continues to deliver high quality care to our patients as recognized through many significant accolades—such as earning a Comprehensive Stroke

Center designation by the Joint Commission in 2013 and being ranked a Top 100 Hospital in the nation for cardiac surgery. These achievements and awards are the result of hospital-wide efforts and a dedicated, skilled nursing staff.

More importantly, however, there is an aspect of quality care that comes from our hearts, one that only our patients and their loved ones can measure—it is compassion. Showing sincere concern and empathy for others through our daily work is what sets us apart, and for many of our patients, it is why they choose Mercy Hospital for their care.

Thank you for your many efforts to constantly enhance the patient experience, keeping the patient first in all that we do, and living up to our Mercy name and spirit of “compassion.”

Sincerely,

C.J. UrlaubPresident and CEO, Mercy Hospital

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A Message From Our Leadership

C.J. Urlaub, president and chief executive officer, Mercy Hospital

Table of Contents

2 Leadership Message 4 Transformational Leadership

6 Structural Empowerment 10 Exemplary Professional Practice

22 New Knowledge, Innovations, & Improvements

Annual Report CoordinatorsBarbara Lawrence, RN, BS, Special ProjectsVicky Loretto, RN, BSN, manager Hospital RelationsMelanie Griffis, Editor, manager Public Relations

Dear Mercy Hospital Nursing Staff,

We are pleased to provide you with a Department of Nursing review focused specifically on the efforts and achievements of our Patient Care Services staff. This report highlights many initiatives to enhance the patient experience, which remains a top priority at Mercy Hospital. We are proud of our work that resulted in a 58.2% overall patient satisfaction rating for 2013, finishing the year four percentage points over our goal. In an effort to keep improving the patient experience, our overall patient satisfaction rating goal is 61.2% for 2014.

This report also highlights the many advances in professional nursing practice at Mercy Hospital as evidenced by the growth and success of unit based Practice Councils, Site Professional Practice Council, Nursing Peer Review Council and the Nursing Research Council initiatives.

Our Unit Practice Councils are based on the concept of “shared governance”. What does that mean? Shared governance is all about shared decision making where staff are in partnership with nursing management and administration to improve the delivery of patient care. Shared governance is about giving the RN at the bedside

ownership of their practice and a voice in how care is delivered. This diverse, creative and expert input from staff enhances patient care and advances the mission of Mercy Hospital.

We also rolled out our Language of Caring program in January. The program is about the importance of compassionate care and how our words and actions influence our patients and families perception of care. Language of Caring encourages all of us to show our hearts and all the love and care we hold there for our patients. We do this through our connection to the patients and families by our touch, smiles, selection of appropriate words and by showing our caring attitudes. We are thoroughly and completely present. Through hourly rounding we proactively strive to meet our patients’ needs.

Each healthcare associate has a role to play but as a TEAM of caregivers we have the strength to move forward and make a difference in the lives of our patients.

I would like to take this opportunity to congratulate and thank all of our dedicated nursing staff for their outstanding efforts in delivering patient-centered care. Please enjoy reading our first published nursing report and all the initiatives that have been accomplished.

Sincerely,

Kathleen Guarino, RN, MS, NPVice President, Patient Care Services/Chief Nursing Officer

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Kathleen Guarino, RN, MS, NP, vice president of Patient Care Services, Chief Nursing Officer

A Message From Our Leadership

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Transformational Leadership

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Nursing Philosophy at Mercy Hospital of Buffalo

The Patient Care Services Division recognizes that professional nursing requires an understanding of the humanistic value system, and that this, combined with the scientific knowledge base guides the nurse’s actions. Nursing is a unique discipline that delivers care based on the nursing process. We further believe that the core of nursing is the practice of caring. Caring is primary to discerning problems, recognizing possible solutions and implementing those solutions. It involves the capacity to appreciate diversity and individuality. We believe that patient care should be based on these identifiable outcomes from the beginning of the hospital stay. These outcomes should be mutually determined by the professional nurse, the patient and the patient’s family/significant other. We believe that the professional nurse is a patient advocate and in that role has the responsibility of informing and protecting the rights of each patient under his or her care.

We believe that holistic caring promotes patient well-being on a continuum of care, thereby providing for the physical, psychological and spiritual needs to lessen the effects of illness and provide comfort and healing for our patients.

Nursing Mission

To provide exceptional patient centered care by compassionate nurses and associates.

Nursing Values

Nursing at Mercy Hospital is both an art and science dedicated to improving the well being of our patients through:

Best Practice Standards • Ensure goal directed, patient focused clinical practices which promotes quality care. • Ensure a continuum of care to our patients through enhanced interdepartmental collaboration (horizontal

integration).

Shared Governance • “Shared Governance is a structural model through which nurses can express and manage their practice with a

higher level of professional autonomy.” (Porter- O’Grady, 2003) • Shared Governance is a partnership between staff and leaders, collectively working toward one goal:

Providing quality patient care. • Within the definition of the nursing profession is autonomy and the accountability to keep the patient at the

center of care. • Unit Practice Councils identify opportunities for improvement in nursing practice on units that will enhance

excellence in patient care. The Unit Practice Council structure is the essential process for staff nurse decision making in operational and professional practice issues at the unit level.

Collaborative Practice • Develop and enhance collaborative relationships between the medical staff and nursing staff to facilitate

effective and efficient practices.

Nursing Strategic Planning - Preparing Nursing for the FutureImprove satisfaction • Improve quality and outcomes • Improve effectiveness

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Staff Development • Provide an environment which generates, supports, and promotes the highest level of professional

preparation and practice among nursing staff.

Fiscal Responsibility • Enhance the value of the clinical services rendered while ensuring the most prudent use of resources.

Mission Effectiveness • Create a dynamic, creative, and committed culture in each nursing department which reflects the core

values of the Catholic Health System.

Mind, Body and Spirit • “Mercy is loving, kindness, concern, hospitality, respect, compassion and we want to be no less than our

name.” (Mother Catherine McAuley)

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Structural Empowerment

Staff Nurses Receive the Daisy Faculty AwardThe Daisy Foundation was established in 2000 by the Patrick Barnes’ family after his death from Idiopathic Thrombocytopenia Purpura (ITP). Patrick’s family wanted a way to thank all the nurses who showed compassionate care to Patrick and to them during this difficult time. The Daisy Award is an acronym for Diseases Attacking the Immune System. The Daisy Faculty Award was created to focus on nursing faculty as they have a profound impact on the future of their students.

Staff nurses Kate Zippier, RN, and Megan Cheyne, RN, both of 5 McAuley North/Center, and staff nurses from Maternal Child and L&D - Ann Moran, Pam Harrington, Karen Warner, Kim Marts, Karen Burchalewski, Michelle Jarosz, Chris Harrington, Debbie Kasper, Vicki Heck, Joan Bossee (retired) and Mary Ann Nowak (retired) were presented DAISY Awards from the D’Youville College School of Nursing for their expertise and excellence in their roles as clinical instructors (CIs). They were chosen for the award by D’Youville’s Dedicated Education Unit (DEU) faculty.

The Maternal Child and L&D Units were the first DEUs at Mercy Hospital.

Institute of Medicine Proposes - BSN by 2020Over recent years, there has been much discussion and decisions in New York State and around the country related to requiring nurses to have a BSN degree.

There are current New York State bills aimed at requiring that new registered nurses earn a bachelor’s degree in nursing within 10 years of initial licensure to keep working in New York State. Current registered nurses would be exempt from the education requirement. This is part of a national push to raise educational standards for nurses. Federal health officials have recommended upgrading nurse education to BSNs for more than a decade and were supported in 2010 by the National Academy of Sciences Institute of Medicine (IOM) and the Robert Wood Johnson Foundation. In 2008, about a third of RN’s had bachelor’s degrees or higher according to federal statistics. The IOM recommended increasing that to 80% by 2020.

Rationale for the change: • Improve patient care • Advancement of RN’s in administrative specialty areas, teaching in nursing schools • Critical thinking skills are needed as patient care becomes more complex • Research has shown that higher levels of education improve patient outcomes and the quality of care

Mercy Hospital is working in partnership with Niagara University to provide staff nurses the opportunity to receive their BSN, tuition free. In 2013, the following nurses completed their BSN degree: Kathleen Barnes, Leah Guerin, Rebecca Klacko, Michelle O’Hara and Jessica Riley. In addition, eight new Mercy nurses enrolled in the second education program of the Niagara University partnership.

Pictured above, from left, are Pauline Blake, RN, 5N/C nurse manager, Daisy Award winners Kate Zippier, RN and Megan Cheyne, RN, and Michelle Mollica, RN, of D’Youville College.

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Angels of Mercy - ICU“Angels of Mercy Soothed our Souls” was the headline of a touching editorial published in the Buffalo News in November 2013. A woman from West Seneca wrote about the compassionate care that her late husband received while a patient at Mercy Hospital. She refers to “one precious ICU nurse who stayed hours after her shift to ensure her husband was comfortable.” That nurse was Afnan Mohamed, RN. Hospital administration presented Afnan with a framed copy of the editorial for the ICU staff to display on their unit.

Mercy Hospital of Buffalo Discharge Call Back ProgramSubmitted by: Gretchen Galliford, manager, Patient Care Experience

Knowing how Mercy Hospital of Buffalo patients are doing after their discharge to home is a very important part of our continuum of care to wellness and to help reduce readmissions. Aligning with our enhancing the patient experience mindset, we want to continue to send the message that we care even after our patients are discharged. Started in June 2010, the program, which is coordinated by a designated RN, involves reaching out to a large majority of inpatients discharged to home via a brief telephone call. The primary focus of the discharge call back process is to reach out to patients at home within 24-48 hours of discharge to:

• Maintain a caring communication between the patient and hospital • Identify how the patient is doing after their hospital discharge • Check if the patient has a follow up appointment(s) with their physician(s) • Answer any questions or redirect their concerns • Aid in “on the spot” service recovery • Pass on any compliments that specifically

mention an individual or a department • Thank them for choosing Mercy Hospital

Feedback shared by 5 McAuley East patients at an April 2013 Patient Focus Group re-confirmed that the discharge calls really make a difference in the entire patient experience. The patients mentioned how nice and comforting it was to receive a compassionate call from the MHB nurse when they were discharged to home. The discharge call back program has also expanded its criteria to better meet the needs of the patients by increasing the call back attempts to three calls after discharge. This has increased the percentage of patients that are now reached. In 2013, the program was further expanded to include the maternity patients.

The ICU staff were presented a framed copy of the editorial. At the presentation were (l. - r.) Lisa LaCongo; Jarrod Atkinson, RN. BSN, ICU nurse manager; Jeanine Davis, RN; Jonathan Bienek, RN; Colette Lopez, RN; JoAnn Morales; Kim Fronckowiak, RN; Kris Spiegel, RN; Tracy Murphy, RN; Tara Hatrick, RN; Mercy Hospital President & CEO C.J. Urlaub; Robin Guerin, ITA; Afnan Mohamed, RN; Jen Carson, ITA; and Mary Rose Graham, RN, BSN, Emergency Services Director.

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20

40

60

80

100

Sem 2

2012

Sem 1

2013

Sem 2

2013

71.776.1

84.4

MHB Inpatient + HCAHPS Total (78.2) NRC Average (77.8)

IP-A Received Phone Call at HomePatients Contacted At Home

Nursing Professional Practice CouncilThe Mercy Hospital Professional Practice Council (PPC) held its first meeting April 15, 2013 and consists of the Unit Practice Council (UPC) members from the nursing areas. This group comes together to collaborate as professionals to share information and exchange ideas to create positive changes, look for improvements when trends are found in practice or care concerns, and seek ways to improve clinical quality/outcomes, as well as the patient experience.

The PPC also provides a forum for direct dialogue with the CNO on topics related to clinical practice, patient/family care, clinical quality/outcomes, staff/patient satisfaction and workflow. This collaborative setting fosters a staff-leader partnership to promote collaboration, shared decision making and accountability for improving quality patient care. This type of forum gives way for an exchange of information from all the UPC meetings related to unit projects and achievements. Participation promotes team building communication among the staff.

Nursing Peer Review CouncilGoals: • Improve patient outcomes • Enhance nursing performance • Increase efficiency of the process for the nursing staff • Identify process barriers impacting patient care • Maintain nursing department educational goals • Improve use of support resources

Scope:The nursing peer review committee will be responsible for evaluating and improving nursing performance in the areas of clinical quality, patient safety, nursing responsiveness, and documentation issues.

Responsibilities: • Initial review of cases of sufficient complexity of management or seriousness of outcome requiring nursing

peer review based on cases referred from: w Quality management w Generic nursing screens

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Professional Practice Council Details

Professional

Practice CouncilPractice, Quality,

Standards,

Professional

Development

Peer Review Council

Quality, Practice,

Review, Chart

Review, Policy &

Procedures

Review

Nursing

Research &

Evidence Based

Practices

Hospital

Associate

Council

(Site)

Mission

Patient

Experience

Supply &

Equipment

Communication

Go

Green

Health &

Wellness

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w Department- or specialty-specific measures w Risk management w Referrals from nursing/medical staff w Case management staff for quality issues• Obtain reviews and recommendations from nursing clinical experts when required• Communicate with the nurse involved in the case to obtain input prior to making determinations when

opportunities for improvement may exist• Make determinations regarding opportunities for individual or system improvements based on individual

case review

Unit Practice CouncilsUnit Practice Councils (UPC) identify opportunities for improvement in nursing practice on units that will enhance excellence in patient care. The Unit Practice Council’s structure is the essential process for staff nurse decision making in operational and professional practice issues at the unit level.

Unit Practice Council on 6 McAuley West Improving CommunicationSubmitted by: Ondrea Bennefield, RN, BSN; nurse manager 6 McAuley West UnitThe staff wanted to improve communications on 6 McAuley West related to answering patient call lights and RN hand off communication at the change of shift. Wanting to make sure call lights are being answered in a timely manner, the staff developed, and are now trialing, a call light log.

The staff on 6 McAuley West also wanted better communication between shifts from RN to RN. 6 McAuley West is now a pilot unit for bedside hand off of care reporting. All RNs come in 15 minutes earlier to receive a bedside report. The Unit Practice Council discusses and evaluates the bedside report monthly. The staff have been doing a fantastic job.

Unit Practice Council Formed on 7 McAuley West UnitSubmitted by: Joan Vetter, RN, BSN; nurse manager 7 McAuley West UnitThe 7 McAuley West shared governance Unit Practice Council (UPC ) was developed in March 2013. Initially the UPC members conducted brainstorming activities to identify and set priorities related to the obstacles and barriers that occurred on their unit that had an impact on patient care.

As the UPC members developed their understanding of shared governance, the staff wanted to improve unit quality outcomes on 7 McAuley West regarding CHF education times. They were focused on completing and documenting the education time in order to meet the goal of 60 minutes of education per patient. Staff decided to track the times education was provided on their shift-to-shift report sheets so each RN had an idea of how much time was needed to get to the goal of 60 minutes of education before discharge. Communication was effective in obtaining their goal and staff is satisfied with their outcomes.

Pictured above, hospital nurses and staff accept a 2013 American Heart Association national quality achievement award for heart failure care.”

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Patient and Family Advisory CouncilIn support of our Mission and Values, the Mercy Hospital Patient and Family Advisory Council is being developed to promote partnership with our patients, families and the community. Patients and families are an integral part of the healthcare team. Listening to the voices of our patients, families and community is vital to the delivery of quality, safe and compassionate care.

The council will bring patients, family members and the hospital staff together in an ongoing effort to enhance the patient and family care experience. The members of this council will serve as key advisors keeping the hospital leaders informed related to issues that are important to the patients, families and the community. The first meeting was held in the first quarter of 2014.

Advisors work in partnership with health care providers to:

• Identify ways of improving the care experience.• Strengthen communication and collaboration among patients, families,

caregivers and staff• Create an environment where patients, families, clinicians and hospital staff all

work together as partners to improve the quality and safety of hospital care.• Review, revise or help to create educational and informational materials for

patients and families.• Promote patient and family support and involvement• Propose and participate in building sustainable patient care programs and

services• Share their stories to help make positive change• Positively link to the community• Advance personal involvement and accountability for one’s own health and wellness • Participate in hospital and community health programs and health and wellness fairs

Discharge Instruction Envelopes5 McAuley East associates participated in a pilot project to develop a more efficient collaborative process between departments and the nursing unit for handling the many different instructions and information sheets that are given to patients during their hospital stay.

Nursing associates, along with the case managers and physical/occupational therapy staff, came up with the concept of a Discharge Envelope. The purpose of the Discharge Envelope was to conveniently consolidate information from multiple departments or services for the patient in one designated envelope when they are discharged.

The associates have found that placing all the discharge information and instructions, including medication information, has helped coordinate and assist with the discharge or transfer process.

Pictured above, the Patient & Family Advisory Council met for the first time in March 2014.

The Council’s logo, pictured above, was chosen by the council members following a review of various designs.

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Hourly Rounding

We provide hourly rounding on our unit to ensure that you receive the best care.

We round EVERY HOUR from 6 am to 10 pm

and EVERY 2 HOURS from 10 pm to 6 am

We will be asking you the 4 P’s:

•Pain: How is your pain?

•Position: Are you comfortable?

•Personal Needs: Do you need to use the restroom or bed pan?

•Possessions: Do you need us to move the phone, call light, trash can, water pitcher, the over-bed table, TV remote, or any items within your reach?

Thank you for allowing us to provide you with anExcellent Patient Experience!

Patient Rounding Pledge The hourly rounding concept was developed by the Studer Group to improve the patient experience. In addition, nursing quality data has shown that hourly rounding can help decrease patient falls and decrease hospital acquired pressure ulcers. Hourly rounding focuses on the “4 P’s” of pain, potty or toileting, positioning and having personal items within reach. Rounding is a proactive approach for staff to anticipate the needs of their patients and to ensure their safety.

The nursing associates on all of the nursing units have been working to conduct consistent hourly rounds during the day time hours and every two hours during the night time hours. Associates have made a pledge to every patient by having a posted sign in every patient room speaking about what patients can expect during the hourly rounding. After asking about the four primary areas of rounding and before leaving the room, they will also ask “if there is anything else that they can do” before they leave the room.

Exemplary Professional Practice

Pursuing Excellence - “Continuing Our Journey From Good to Great”Over the past years, Mercy Hospital has been focused on improving the patient experience. Several programs have been offered to all the Mercy Hospital associates and physicians to improve communications and approaches while interacting with patients, families and visitors. First, AIDET communication skills were taught. AIDET is an acronym that represents the 5 actions:

Acknowledge • Greet people with a smile and use their names. • Create a lasting impression and make a connection with others.

Introduce • Tell people who you are and how you are going to help them. • Escort people where they need to go.

Duration • Let people know timeframes and keep them updated.

Explanation • Teach and communicate processes.

Thank You • Be grateful and thank people. • Thank people for using our facility.

The Enhancing the Patient Experience Parts I & II Seminars were offered to associates to develop additional skills to promote effective and caring communications. Skills learned during these training sessions included:

Purposeful Rounding (Studer Group) • Focusing on best practices of purposeful patient rounding. Patient rounding includes questions related to

pain and comfort, toileting needs, positioning, personal items within reach and asking if there is anything else that can be done before leaving the room.

Heart-Head-Heart Communication (Leebov Golde Group) • Introduction to caring communication skills that will enhance the patient experience.

Emotional Intelligence and Verbal Judo • “Responding” professionally using thoughtful verbal language representing “on-stage” behaviors and

thinking before speaking.

H.E.A.T. Service Recovery • Hear them out - listen • Empathize – walk in their shoes • Apologize – saying you’re sorry for how they feel. “I am sorry the situation occurred, I am glad you told me

about it and how can I make it better for you.“ • Take responsibility to correct and resolve concerns

“10/5 Rule” (Studer Group) • As people are approaching, at 10 feet make eye contact and smile and when people are within 5 feet greet

the person with a “Hello.”

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Pursuing Excellence – Enhancing the

Patient Experience

Language of Caring(LOC) Program:

Starting in October 2013, our Enhancing the Patient Experience training continued with the Language of Caring Program developed by Wendy Leebov and Jill Golde. The Language of Caring program focuses on putting caring and compassion back into communications. Compassionate communications reduces patient and family anxiety and fears with the anticipation of improving patient outcomes and enhancing the patient experience. Caring, empathy and compassion becomes visible in all aspects of verbal and non verbal communication between healthcare workers, physicians, patients and family members.

Every Mercy Hospital associate and hospital physician is required to attend this program. This program includes a 2 hour jumpstart session and then ten 30 minute training modules with habit builder exercises and re-demonstration of skills and techniques learned. These sessions will be spread over 2014 – 2015. All Mercy managers received the overview program training. In addition, a two day facilitator training was conducted for 24 managers, 17 associates and 2 hospital physicians from all areas of Mercy Hospital. The facilitators then conducted the 2-hour jumpstart training sessions for all associates and continue to assist with the monthly module training that began in January 2014. The trained LOC “Jumpstart” facilitators are:

Amanda Thourling Amy DiPasquale Anne McGillicuddy Barb Lawrence Brandon Thompson Brenda RobinsonCarl DePalma Colleen Raczynski Kate ZippierDale McGuire David Gaswronski Tina DonovanDon Larson Donna Bohan Tony Dougher Elaine Keegan Elizabeth Galvin Susan KeefeGretchen Galliford Jarrod Atkinson Stephen HandzelJennifer Thoms Jeret Wedzina Richard SzabalaJoan Vetter Joy Kent Shanel OrsiJulie Womack Karen Kochanski Penny TirpakKathleen Hayes Keri Hendrix Penny JetterLuann McCoy Marsha Nowak Peggy BlenskiMargaret Priester Mary Hudson Nancy RodriguezMaureen Sullivan Megan Cheyne Dr. Thomas Raab Dr. Stephen Chrzanowski

13Participating in a training session for the Language of Caring program were, from left: Keri Hendrix, PACU; Dr.Thomas Raab, chairman, Dept. of Medicine; Barb Lawrence, RN, Patient Care Services; Peggy Blenski, Care Management; Elizabeth Gavin, RN, 6 East; and LuAnn McCoy, Care Management.

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At an increasing rate, patients and families are utilizing the internet and the many healthcare quality web sites to compare the quality of the hospital or services that they will utilize. It is vital that Mercy Hospital be competitive in meeting and/or exceeding all the quality targets. Meeting established targets has an impact on how we are able to utilize the funds to reinvest in staffing, renovations and equipment to better care for our patients, families and associates.

The Language of Caring program is designed to give all associates and physicians the skills and tools to consistently provide exceptional experiences to patients, families, and to each other.

The 10 LOC training modules, which began in March 2014, include: 1. Introducing The Language of Caring 2. Heart-Head-Heart Communication 3. The Practice of Presence 4. Acknowledging Feelings 5. Showing Caring Nonverbally 6. Explaining Positive Intent 7. The Blameless Apology 8. The Gift of Appreciation 9. Say it again with HEART 10. The Language of Caring: From Good to GREAT

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2009

(n=646)

2010

(n=428)

2011

(n=384)

2012

(n=2,192)

2013

(n=2,608)

42.746.7

54.952.9

58.2

MHB Inpatient + HCAHPS Total (53.8) NY Average (59.8)

HCAHPS: Rate Hospital

Continued from page 13

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Improved Patient Satisfaction with Effective Pain ManagementSubmitted by: Diane Glowacki, RN, MSN, CNBN, CMC, Clinical Nurse Specialist In collaboration with the National NDNQI “National Data of Nursing Quality Initiatives” (NDNQI), Mercy Hospital of Buffalo participated in a national pain study which was initiated March 2011 and completed December 2011. The study was titled: “Coordinating Center for Dissemination and Implementation of Evidenced-Based Methods to Measure and Improve Pain Outcomes.”

The goal of this study was for the participating hospitals to implement and evaluate an innovative translational research program to measure and improve pain care processes and outcomes. Two medical/surgical units at Mercy Hospital participated in the NDNQI study.

Four hundred hospitals nationwide were invited to participate in phase I of the NDNQI study. Mercy Hospital was then invited 5 months later to participate in phase 2 of the study, one of 312 facilities nationwide chosen to participate. Phase 2 was designated to take place over a 3 month time period. An interdisciplinary team of clinical experts was developed for each of the two selected units and generated strategic and practical problem solving initiatives which could be accomplished during the defined time period.

The team consisted of Diane Glowacki, Clinical Nurse Specialist (CNS) as the project coordinator, Pauline Blake, Nurse Manager, Don Larson, Pharmacist and Laura Harter, Amy Jordon, Karen Kliber, and Tracy Loehr, RN staff members. Together the team developed an action plan that included three objectives: • Education of the staff on pain management • Distribution of pain folders to the patients who met the eligibility criteria using some of the pain

educational material provided by NDNQI • Implementation of daily interdisciplinary team pain rounds on those patients

The nursing unit’s pain rounding team included the CNS, nurse manager, pharmacist and the primary RN.

Improved Patient Satisfaction with Effective Pain Management

In collaboration with the National Data of Nursing Quality Initiatives (NDNQI), Mercy Hospital of Buffalo participated in a national pain study which was initiated March 2011 and completed December 2011.The study was titled: “Coordinating Center for Dissemination and Implementation of Evidenced-Based Methods to Measure and Improve Pain Outcomes”.

The goal of NDNQI study was for the participating hospitals to implement and evaluate an innovative translational research program to measure and improve pain care processes and outcomes. Two medical/surgical units at Mercy Hospital participated in the NDNQI study. This collaborative study prefaced the initiation of the Mercy Hospital of Buffalo’s hospital-wide pain study.

First, to apply the successful initiatives implemented in collaboration with the NDNQI study for improved pain management relative to patient satisfaction on all of the hospital’s medical/surgical units.

Second, to evaluate the impact of the disseminated and implemented strategies from the NDNQI study, as well as identifying particular barriers in improving pain management at the nursing unit level.

Background

Purpose

References

Acknowledgements

National Database of Nursing Quality Indicators. Pain Care Quality Study, 2011.National Research Corporation, 2014.The Joint Commission, Speak UP Brochure. What You Should Know About Pain Management. www.jointcommission.org

Pain Team Committee- Mercy Hospital of Buffalo

Developed an interdisciplinary team of clinical experts from nursing and pharmacy and generated practical problem solving initiatives. This interdisciplinary team provided: •education to the staff on pain management •distribution of informational packets on pain to patients •implementation of daily interdisciplinary team pain rounds on all patients.•The pain rounding team included:mClinical Nurse SpecialistmNurse ManagermPharmacistmPrimary RNmCollaboration with the physician/provider •The study was completed by the end of the first quarter 2012.•National Resource Corporation Picker patient experience scores related to pain management were used for the analysis of the data.

Research Design, Samples, and Methods of Analysis

The results of this study demonstrated significant improvement in patient satisfaction scores for pain management as a result of a collaborative interdisciplinary team and the implementation of daily pain rounding. This initiative was consequently instituted throughout the Catholic Health acute care facilities which Mercy Hospital is a member.

Results and Conclusions

Both Nursing and Pharmacy practices have changed as a result of this evidence based study. The pain management transformation has led to significantly improved patient outcomes, improved pain management methodologies as well as improved patient satisfaction. Increased physician engagement with pharmacy and nursing has led to a team approach in providing effective pain management for the patients.

Implications for Practice

Diane Glowacki MSN, RN, CNRN-CMC

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The data results we received in January 2012 from the NDNQI linked our initiatives with improved pain management for our patients. Also seen was a significant increase in patient satisfaction benchmarks for pain management. The results demonstrated the success of interdisciplinary team work. The education of staff and daily pain rounds was then implemented throughout the hospital and completed by the end of May 2012. Approximately by the end of the 3rd Quarter 2012, the pain rounding process was established system wide throughout CHS acute care facilities.

Both nursing and pharmacy practices have changed as a result of this evidence based study. The implications have led to improved patient outcomes, improved pain management methodologies as well as improved patient satisfaction.

Charge Nurses Assist in the Role of Pain RoundingSubmitted by: Diane Glowacki, RN, MSN, CNBN, CMC; clinical nurse specialistThe charge nurses at Mercy Hospital assist with pain rounds with the pharmacist on most units. This allows the charge nurses to become more engaged with patients and families and also provides consistency of pain rounding 7 days a week.

The charge nurses have had a very positive and enthusiastic response. Some of the testimonials have been:

“ I like getting to know the patients better and that they also get to know me. The patients are happy to see me the next day, or until they are discharged.”

“Pain rounds include addressing many other issues as well, and it is a good feeling that I can resolve some of them, I feel like I’ve made a difference.”

“ I have noticed that the MD’s /providers respond so much quicker to requests for pain management. They are more willing to provide the patients with other pain medication options.”

“ I like knowing that the patient feels more comfortable and their comfort levels have improved and that I was able to intervene for them. The patients are so grateful and thankful.”

Participating in pain rounding, pictured above,are: (l.-r.) Karen Kliber, RN; Laura Rothenberg, RN; Tracy Loehr, RN; Amy Jordan, RN; Don Larson, pharmacist; Diane Glowacki, RN, CNS; and Pauline Blake, RN, 5 N/C nurse manager.

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National Database of Nursing Quality IndicatorsMercy Hospital has particpated in submitting data to the National Database of Nursing Quality Indicators (NDNQI) since 2006. NDNQI enables Mercy Hospital to get actionable data, access unit-level reporting, and compare with peer hospitals nationally, regionally, or at a state level.

Mercy Hospital has improved its hospital acquired pressure ulcer rate from 4.40 in 2012 to 4.19 in 2013. Our fall rate has remained constant at 2.85. Hourly rounding, turning and positioning, and appropriate falls prevention measures will help us achieve national benchmarks.

Improving Outcomes in the Critical Care Areas & 7 McAuley West UnitSubmitted by: Jarrod Atkinson, RN, BSN; nurse manager ICUFollowing evidence based practices for patient care and anticipating improving hospital acquired infections in the ICU, CCU, OHU, and 7 McAuley West, the units began bathing patients with 2% Chlorehexidine (CHG) bath wipes in October 2013. Patients are bathed with these wipes over all body surface areas from the neck down; soap and water may be used on the neck up.

The wipes are stored in a special warmer until they ready to use for patient comfort. These wipes are a wonderful addition to current infection prevention strategies and their use has been met with great enthusiasm from staff. The nursing units are looking forward to seeing the impact of this practice change for the improved care of their patients.

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2010

47.9

55.6

52.9

MHB HCA HPS Total (61.8) NRC Average (64.0)

HCAHPS : Pain well controlled during stay

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Qtr 2

2012

Qtr 3

2012

Qtr 4

2012

Qtr 2

2013

Qtr 3

2013

Qtr 4

2013Qtr 1

2013

62.7

56.9

48.2

66.1

63.860.7

63.6

75.0

53.3

73.3

65.3 64.9

69.6

18Staff from the 5 McAuley West Unit are, from left, Karen Kochanski, RN, nurse manager; Lisa Schunk, RN; Mary Hudson, RN; Donna Sciandra, unit clerk; Gloria Sawyer, RN; Ellie Geiger, RN; Katie Glauber, NA; Molly O’Neil, RN; Kathy Bukolt, NA; and Andrew Janis, NA.

Improving the Patient Experience on 5 McAuley East UnitSubmitted by: Karen Kochanski, RN, BSN, nurse manager 5 McAuley East UnitUnder the guidance and support of C.J. Urlaub, MHB President and CEO and Kathleen Guarino, MHB VP Nursing and CNO, the initiative to pilot strategies to improve the patient experience and patient satisfaction on 5 East was started in November 2012. The goals of this initiative was to: • Develop an interdisciplinary team including all departments that have an impact on direct and indirect

patient care on 5 East. • Develop strategies to improve how each department was providing care/services, how they supported the

unit, or how they interacted with the patient or staff on the unit. • Encourage ownership of the NRC Picker patient satisfaction scores on 5 McAuley East as a team. • Make changes to current processes to improve patient interactions and ultimately improve the patient

satisfaction scores. • Role out the successes to other nursing units.

During 2013, interdisciplinary meetings progressed from every two weeks to monthly to brainstorm new ideas, evaluate any process changes and establish the “next steps.” Department managers worked collaboratively with their associates to brainstorm ideas specific to their areas that would improve the patient’s overall patient experience while on 5 McAuley East.

Working collaboratively, the pilot project team was able to accomplish the following improvements: • Facilities - Nursing unit “spruce up” including painting patient rooms, installation of automatic towel

dispensers in patient bathrooms and the placement of automatic dimmer lighting in the hallways so after visiting hours the lighting is softened.

• Environmental Services - Floor stripping and waxing, bathroom powerwashing, assignment of consistent personnel to the unit and scripting of staff.

• Dietary –Hand wipes added to the meal trays, consistent personnel assigned to the unit, scripting of staff with a genuine pleasant approach and a willingness to make meal times a pleasant experience.

• Pharmacy – Daily patient rounds with the nurse manager or charge nurse to discuss medications, pain management and answer questions.

• Transport – Patients were able to be transported to and from departments and discharge within 15 minutes from the time of request and handing the patients the signed Thank You card as they are leaving.

• Therapies (PT, OT, Speech) – Assists with patient ambulation to the chair or in the hallways and assisting in scheduling swallowing screening evaluations

19

0

20

40

60

80

100

2012

(n=171)

2013

(n=313)

45.0

54.6

MHB 5 McAuley East Total (51.2) NRC Average (70.3)

HCAHPS: Rate Hospital

NYS Average (59.8)

• Case Management – working to place the patients back to their homes or to the required facility to provide for the patient’s determined level of care.

• Pastoral Care – Assists in the spiritual aspect of care providing emotional support and prayers with patients and families.

• Volunteer Services – Developing a hospitality cart with reading material, magazines, puzzles, reading glasses and newspapers for patients.

• Nursing – Hourly rounding, use of Discharge Envelope, development of a unit brochure given to all new patients by the charge nurses, “quiet at night” hanging door signs, use of discharge “Thank You” cards signed by nursing staff and all staff that participated in a patient’s care, standardized staff expectations, and purchase of needed equipment for the unit

In April 2013, former 5 McAuley East patients were invited to participate in a Patient Focus Group. It was important for the interdisciplinary team members, staff and administrator to hear from patients the positive aspects of their hospital stays and areas for improvement. This was a very positive experience and valuable information was learned. The patients wanted to be in a caring environment where healthcare professionals listened to them and their families, took the time to make the human connection and the workers would take a few minutes to make a personal connect through touch, smiles, and concerns. They wanted to feel safe. The former patients spoke favorably about receiving the signed Discharge Thank You cards and the Discharge Phone calls.

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Members of the MORE OB team from the Labor and Delivery and Maternity Departments were recognized for their outstanding efforts with this multi-year patient safety and performance improvement program.

Maternal Child Focus Groups Provide Valuable FeedbackSubmitted by: Mary Ann Murphy, RN, BSN, director of Maternal Child ServicesIn October 2013, Mercy Hospital worked with Ken Rogers, an independent consultant, to host a Maternal Child patient focus group. The randomly selected group of patients came from a diverse, cross section of the population serviced by Mercy Hospital’s Maternal Child program. Mothers who had both uncomplicated vaginal and cesarean births, along with mothers who had complicated pregnancies and required prolonged hospitalizations were present to meet in a comfortable setting.

The group spoke freely about their birthing experiences. A multidisciplinary team of associates, physicians and administrators met to observe the groups’ interview from behind a 2-way mirror. The session was also videotaped for a presentation to an additional 20 associates at a combined unit practice council meeting. This very enlightening experience reinforced many of the positive aspects of clinical care delivered in the Maternal Child area. The comments solicited from attendees gave purposeful direction for the entire group working to enhance the patient experience.

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NICU Improves Infection ControlSubmitted by: Joy Kent, RN, BSN, nurse manager, Maternity & NICUIn early 2013, the NICU experienced an unusual and isolated increase in their infection rate. The nursing staff worked closely with the CHS Infection Control team and their physician leader, Dr. Kevin Shiley to analyze the data, identify a primary cause and decrease the rate of infection.

The following actions were taken: • Hand hygiene clinics were established to provide every staff member with the opportunity to evaluate their

own hand hygiene technique using the Glow Germ blacklight • A change in the daily cleaning of each individual workstation by each RN at the start of their shift, limiting

the use of emollients to the diaper area only, • Changing the venipuncture preparation technique, as well as adding additional hand sanitizer stations in

care areas.

The NICU has not experienced any additional infections for 12 months!

In above photo,(l.-r.) NICU staff Anna Margaret Chase, RNC, Mary Ellen White, RN, Christine Harrington, RN, and Linda Filipiak, RN, look over some new equipment received for newborn care.

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New Knowledge, Innovations & Improvements

Reinvesting in Patient Care EquipmentSubmitted by: Carol Latona, RN, BSN, MBA director, Medical/Surgical Nursing, Patient Care ServicesIn 2013 over $368,000 was reinvested in equipment on the nursing units. The associates and mangers identified the need for equipment to enhance their ability to care for patients.

The following equipment was purchased:

Gaymar pumps (28) – Critical Care Bladder scanners – 8E/ICU, 5N/C, ED Hypothermia machine – ICU, CCU Dynamap – 8E, 6E, 5W, 6W, 5E Wheelie – 8E, 6W, 7W Refrigerator – 8E, 6W Cardiac lounge chairs – 6E, CCU Recliners & Geri chairs – 6E, 5W, 5E, 8E Pediatric dynamap – ED Glucometer – CCU Thermometers – CCU Suction gauges – CCU Phototherapy – Peds Labor beds – L&D

New baby warmers – L&D Baby scales – L&D Electric doors – L&D Telemetry – 5E, 5W Doppler – 5W, 8E Telemetry packs – 5N/C Over the bed tables (65) – nursing units Bedside stands (111) – nursing units Soft ID printers (13) – nursing units Treatment carts – ED, MACC Dialysis RO equipment Dialysis Phoenix system

New IV Pump, SCD and Feeding Pump ProcessSubmitted by: Carol Latona, RN, BSN, MBA, director, Medical/Surgical Nursing, Patient Care ServicesMercy Hospital has hired an equipment technician to improve the IV, SCD, and feeding pump process. Associate Susan Smith works Monday through Friday from 6:00 am - 2:00 pm and assists with bringing pumps down from the nursing units to the Sterile Prep area, cleaning them, and then transporting them to departments where they are needed.

Mercy Hospital Achieves Recognition for Stroke CareSubmitted by: Shirley Duane, FNP, CNRN, stroke coordinator MH Stroke CenterMercy Hospital has achieved the “triple crown,” meaning we earned the Comprehensive Stroke Center designation by the Joint Commission, Gold Plus by the AHA/ASA and Target Stroke (greater than 50% of our patients received tPA in less than 60 minutes).

Mercy Hospital has become the first hospital in Western New York and second in the state to be named a Comprehensive Stroke Center by The Joint Commission, the nation’s leading accrediting body for hospitals and health providers.

Comprehensive Stroke Center Accreditation recognizes hospitals that have state-of-the-art facilities and highly trained physicians and staff to treat the most critically ill stroke patients. Mercy Hospital underwent a rigorous two-day survey in November 2013 with Joint Commission experts looking at all aspects of stroke care from advanced imaging services, to 24/7 availability of specialized treatments, to staff qualifications and competencies.

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New Knowledge, Innovations & Improvements Recognized for ExcellenceQuality Care Recognition from Healthgrades® (a national, independent health care research firm)One of Healthgrades America’s 100 Best Hospitals for Cardiac Surgery™ in 2014One of Healthgrades America’s 100 Best Hospitals for Prostate Surgery™ in 2014One of HealthGrades America’s 100 Best Hospital for Orthopedic Surgery, Spine Surgery & Prostate Surgery in 2013

Cardiac Recipient of the Healthgrades Cardiac Surgery Excellence Award™ in 2014 Five-Star Recipient for Coronary Bypass Surgery for 4 Years in a Row (2011-2014)

Orthopedic Five-Star Recipient for Hip Fracture Treatment for 3 Years in a Row (2012-2014) Five-Star Recipient for Spinal Fusion Surgery for 4 Years in a Row (2011-2014)

Gastrointestinal Five-Star Recipient for Esophageal/Stomach Surgeries in 2014 Five-Star Recipient for Gallbladder Surgery for 2 Years in a Row (2013-2014)

Appendectomy Five-Star Recipient for Appendectomy for 4 Years in a Row (2011-2014)

GYN Surgery Recipient of the Healthgrades Gynecologic Surgery Excellence Award™ for 2 Years in a Row (2012-2013) Among Top 10% of Hospitals Evaluated For Gynecologic Surgery in 2013 Five-Star Recipient for Gynecologic Surgery for 3 Years in a Row (2011-2013)

Men’s Health Services Recipient of the Healthgrades Prostate Surgery Excellence Award™ for 3 Years in a Row (2012-2014) Ranked Among the Top 5% in the Nation for Prostate Surgery for 2 Years in a Row (2013-2014) Five-Star Recipient for Prostate Surgery for 3 Years in a Row (2012-2014)

Highest Quality Rating for Heart Surgery – Top 13% national quality rating from STS (Society of Thoracic Surgeons); national rating of 1070 hospitals, July 2012 – June 2013. A 3 out of 3 Star Rating (***) for Heart Surgery program. The Heart Center at Mercy Hospital has been awarded a top 3-star rating in 7 out of 10 reporting cycles since 2008

Designated as a Comprehensive Stroke Center by The Joint Commission the nation’s leading accrediting body for hospitals and health providers – Mercy Hospital was the first hospital in Western New York, and one of only two in New York State, to earn this special recognition in 2013. (2013 - 2015)

Blue Distinction Center for Spine Surgery, Knee and Hip Replacement (BlueCross BlueShield 2013)Blue Distinction Center for Cardiac Care (BlueCross BlueShield 2013) – This program recognizes hospitals across the country that have a proven track record for delivering better results, including fewer complications and readmissions, than hospitals without these designations.

AHA Gold Plus Quality Achievement Award for Stroke Care (2013- 2014) – The American Heart Association (AHA) awarded Mercy Hospital the Gold Plus Quality Achievement Award for stroke care, recognizing the hospital’s commitment to delivering high quality care for stroke patients.

AHA Gold Plus Quality Achievement Award for Heart Failure Care (2014) – The American Heart Association (AHA) awarded Mercy Hospital the Gold Plus Quality Achievement Award for heart failure care, recognizing the hospital’s commitment to delivering high quality care for heart failure patients.

OUR MISSIONWe are called to reveal the healing love of

Jesus to those in need.

OUR VISIONInspired by faith and committed to excellence, we will lead the

transformation of health care in our communities.

OUR VALUESReverence

Nursing reflects our values and mission by the acknowledgement of the sacredness of human life

and the individuality of their needs and goals.

Compassion Nursing provides compassionate care by identifying the connectiveness of each person

through the relationship with each other and their environment.

Justice Nursing advocates for our patients to achieve their personal goals, respecting

and recognizing the differences in each individual.

ExcellenceNursing continually strives for quality and excellence through the care we deliver through communication to our patients,

families and the interdisciplinary team.

Nursing strives to interact with our patients to achieve their goals, promote, maintain and sustain health and to ensure satisfaction of the care the patient receives.