2015 Nursing Annual Report -...

2015 Nursing Annual Report 1

2015 Nursing Annual Report

2 2015 Nursing Annual Report 3

A Magnet Hospital is one that has been recognized by the

American Nurses Credentialing Center (ANCC) as a facility

that has demonstrated excellence in nursing services. AnMed

Health remains one of three in South Carolina (the ONLY

one in the Upstate) and one of 441 organizations nationally

and internationally to hold this prestigious designation. Some-

thing we can all be proud to embrace!

The healthcare environment is continuously changing –

advanced medical homes, accountable care organizations,

transition coaches, telemedicine, consumer engagement and

technology diversification, pose unique challenges for provid-

ers and opportunities for patients. As a Magnet® designated

healthcare organization, how we respond to these challenges

and opportunities to ensure ongoing excellence and safe qual-

ity care, in an environment that also ensures the safety and

well-being of our team, is critical.

The passion and compassion evident in the care our nurses

deliver every day is truly amazing. Having earned designation

as a Magnet® hospital in 2012, and in the process of undergo-

ing redesignation in 2016, it is clear that our nurses have made

the commitment to sustain the highest excellence in nursing

practice. We consistently challenge ourselves to do more for

our patients and more for our community.

In this year’s annual report we are sharing the successes we

have achieved and the milestones we have met and exceeded.

As our Magnet journey continues during the redesignation

process, we are excited for the opportunity to show the great

work happening every day by the caring and compassionate

professionals at AnMed Health .

Thank you to our staff for your time, talent and passion you

invest in caring for and supporting the people we serve. We are

proud of what you do every day for our community.

Tina Jury, Excutive Vice President for

Hospital Operations and Chief Nursing Officer

Letter from CNO

The American Nurses Credentialing Center designated Magnet status for AnMed Health Medical Center, Women’s and Children’s Hospital, LifeChoice and AnMed Health Home Care.

Letter from the Chief Nursing Officer ....................................................... 3

Transformal Leadership .............................................................................. 4

Structural Empowerment ......................................................................... 10

Exemplary Professional Practice .............................................................. 18

New Knowledge ....................................................................................... 24

Epirical Outcomes ..................................................................................... 28

Letter from

Ch

ief Nu

rsing

Offi

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Tina Jury, RN, MSN, NEA-BC


Three receive the Palmetto Gold Award

The South Carolina Nurses Foundation recognized three

AnMed Health nurses among the state’s best. David Cothran,

Darlene Hoyle and Doris Street were among the recipients of

the 2015 Palmetto Gold Award.

South Carolina has more 61,000 licensed nurses and only 100

are honored each year with the Palmetto Gold Award. Ac-

cording to the South Carolina Nurses Foundation, these nurses

exemplify excellence in nursing practice and have a proven

commitment to their profession.

“We are extremely proud of our Palmetto Gold recipients,” said

Tina Jury, AnMed Health’s executive vice president for hos-

pital operations and chief nursing officer. “They demonstrate

daily a deep commitment to the people we serve and to their

colleagues. They are shining examples of caring professionals

who have dedicated their lives to this purposeful profession.”

The Palmetto Gold Nurse Recognition and Scholarship Pro-

gram is South Carolina’s only statewide recognition program

for nurses from all practice settings. The South Carolina

Nurses Foundation honors each year’s recipients during its an-

nual Palmetto Gold Gala.

The Palmetto Gold Program started in January 2001 with a

meeting of nurse leaders. Their goal was to form a statewide

nursing recognition program that showcases nurses’ contribu-

tions to patient care and raises scholarship funds for students

pursuing an RN.

The first Palmetto Gold Gala held in May 2002 raised enough

money to award a $1,000 scholarship to each of the state’s

23 approved registered nursing programs. Palmetto Gold has

awarded more than $300,000 in nursing scholarships.

AnMed Health recognizes nurses who set the Gold standard AnMed Health recognizes nurses who set the Gold Standard

Four winners were picked for the 2015 Gold Standard nurse

awards. Russell Hendrix and Blake Wilson, two nurses who

established a reputation for constantly working for positive

changes, were the spring recipients, while Hope Campbell and

Melissa Haynie were recognized in the fall – Campbell for her

work as director of AnMed Health Women’s and Children’s

Hospital, and Haynie for her leadership in pain management.

Russell Hendrix

Hendrix demonstrates leadership and

assists others in growth and develop-

ment. He encourages peers in their

practice areas and acts as a role model

to inspire others to improve quality

of practice. Hendrix serves as shift

leader when necessary and is a valuable

resource for knowledge on policies and practice.

He is known for always looking for ways to improve unit poli-

cies and procedures and brings his ideas to the nurse manager

often. Those ideas frequently contribute to a more efficient

work environment for co-workers and a better place for our

patients to heal.

Hendrix’s hands are never idle. While caring for patients he

is always looking for beneficial experiences for students and

opportunities to improve the unit.

Everyone who works with Hendrix knows he is always willing

to help coworkers on the job, just as he is always willing to

help the community. When off duty from AnMed Health,

Hendrix serves his community as a volunteer firefighter.

Blake Wilson

Wilson sets a high standard for other

nurse managers to follow when it comes

to projecting and living a daily life of

being positive at work. He approaches

all challenges by anticipating a positive

outcome.

Wilson came to AnMed Health with extensive psychiatric

and substance abuse patient care experience. He took on the

challenge of providing presentations and education sessions

for more than 100 staff at AnMed Health on proper assess-

L to R: Darlene Hoyle, David Cothran and Doris Street

Transfo

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Transformational LeadershipRaising the level of motivation and performance


ment utilizing the CIWA scale and managing the patient with

alcohol abuse or addiction issues.

He also took the same education to nursing units. He coached

his staff and encouraged them to obtain their psychiatric nurs-

ing certification.

Hope Campbell

Campbell, who served as director of

the Women’s and Children’s Hospital,

has made numerous contributions to

nursing at AnMed Health, including

development of a successful bariatric

program that has become a Center of

Excellence.

She led the application for Baby Friendly designation; men-

tored and facilitated the first AnMed Health nurses to become

certified in behavioral health, bariatric and maternal child;

and has been a leader in efforts to score highly in the PRC

awards for patient satisfaction.

Campbell led several initiatives to improve the patient experi-

ence. Moving the total hip and knee replacement population

to the North Campus ensured an exceptional patient experi-

ence and has a measurable quality outcome for patients. She

led the effort to integrate involuntarily committed patients

into the behavioral health model of care for patients on 8

South, and Campbell worked with OB physicians and office

staff to provide prenatal education needs for mothers. Under

her guidance, there are infant and child CPR classes for par-

ents and a continuing effort to develop 24/7 lactation services

for new moms.

Melissa Haynie

Haynie serves as the pain resource nurse

for ICU. She provides education to the

nursing staff on the latest evidence-

based practices and hospital policies.

She completes pain audits and provides

feedback and education on pain-related

topics. Haynie also serves often as shift

leader, which requires her to conduct and lead safety huddles,

act as support for staff nurses and play an integral role in shift

operations including staffing assignments and adjustments.

Haynie also works outside the unit as a hospital-wide ACLS

instructor in Nursing Staff Development. She educates nurses

to become ACLS certified and maintain their certification.

Haynie’s peers consistently recognize her exceptional caring

and commitment to patients, families, student nurses and

colleagues. The ICU Unit Council unanimously elected her

“Rockstar” of the first quarter of 2015.

Haynie is relentless in advocating for her patients’ needs. Her

recent intervention on behalf of a patient needing plasma-

pheresis not only facilitated the treatment quickly, but kept

the patient’s family calm and positive during a very long day

of medical care. The Gold Standard Nursing Award celebrates

registered nurses who embody AnMed Health’s mission, vision

and building blocks. Nurses are nominated by their peers and

the winner is selected through a blind screening process.

Karen Smith named an Extraordi-nary Woman in Health Leadership

Karen Smith, RN, ACM, was named the Mildred Jones Ex-

traordinary Woman in Health Leadership at AnMed Health’s

annual event to recognize women in the organization who are

leading the way.

Smith manages the UM department for AnMed Health and is

a valuable asset for both the Resource Management Depart-

ment and the hospital.

Her motto is “we wear many hats.” She supervises the precer-

tification specialists, Utilization Management as well as the

denials management area. She is a member of the American

Case Management Association and is one of three nurses at

AnMed Health in 2015 who was an Accredited Case Man-

ager, ACM. She was the first ACM at AnMed Health. She

Dr. Donna Millar-Potts, Karen Smith and Dr. Natawadee Young, l-r, were named Extraordinary Women.

encourages staff to grow professionally as well as personally. Her

nominator said she embodies the AnMed Health mission and

vision by seeking the best outcomes for patients while remain-

ing fiscally responsible.

Anesthesia honored for education

The USC Graduate Program in Nurse Anesthesia recognized

the AnMed Health Department of Anesthesia as the clinical

site of the year. The program is based out of Palmetto Health

Richland and students rotate to other training sites, including

AnMed Health. The Class of 2015 chose AnMed Health as the

affiliated site that provided the best overall experience.

Capacity Planning helps nurse managers prepare for staffing needs

AnMed Health uses a capacity planning computer program to

anticipate staffing needs, enabling nurse managers to be better

prepared for seasonal spikes in admissions.

Sixty-six percent of admissions come from the Emergency De-

partment – well over the national average of 50 percent – but

the volume driven beyond the ER doors to hospital inpatient

rooms can be predicted reliably using the McKesson Capacity

Planner™, a continuous toolset for aligning staffing to fluctuat-

ing needs.

In 2013, AnMed Health executives decided it was time to take

a comprehensive look at their staffing and capacity manage-

ment strategy. They selected the McKesson Capacity Planner

to streamline the process and worked for a year with a McKes-

son business advisor experienced in healthcare operations,

capacity management and organizational change.

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Using this tool to determine accurate patient forecasts, plan-

ners have been able to notify resource managers of predicted

high or low census periods. Managers then have time to

reconfigure units and manage staff. For example, one nursing

unit was closed a month earlier than usual for the season and

reopened as an observation unit. Two other units were merged

to create economies of scale. Over Thanksgiving, managers

were able to temporarily close another unit with an unexpect-

edly low forecast, enabling more staff to enjoy the holiday at

home.

At first, the idea of opening and closing units based on fore-

casted demand was completely foreign. But not for long.

“Nursing units operating at full capacity are able to maximize

their numbers of unit staff,” says Bryan Kennedy MS, RN,

NE-BC, director of Nursing, Medical/Surgical. “Our goal is to

create the best environment for our nurses and other staff to

provide the exceptional care our patients deserve.”

Knowing in advance precisely when to expect winter surges

and how to schedule accordingly has also reduced dependence

on agency nurses. “2014 was the first winter in a long, long

time that we used minimal agency nurses,” says Kennedy.

Combining tools for better results

AnMed Health already had been using McKesson Performance

Visibility™ to manage patient flow for several years. The clini-

cal communication system tracks patient status from admis-

sion to discharge, using color-coded icons to display current

information against the hospital’s floor plan. The combination

of reliable forecasts coming out of McKesson Capacity Plan-

ner and real-time patient status information displayed by the

McKesson Performance Visibility proved to be a trustworthy

source of timely information. Both systems use the same feed

for admission, discharge and transfer data, providing a detailed

perspective on what is happening now and what is projected

to occur in the near future. Opportunities to utilize the two

solutions together soon became apparent, beginning with

discharge targeting.

Early on, data from McKesson Performance Visibility showed

patients’ actual lengths of stay (ALOS) exceeded daily

projections. An initiative was started to improve discharge

rates throughout the hospital. During the daily bed meeting,

attendees began reviewing projected daily discharges against

what was happening – or not happening – at the bed level that


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might throw discharge numbers off from predictions.

“Seeing lengths of stay of four to seven days pushes nurses

to think critically about what delays their patients may be

experiencing and how that impacts their unit overall,” Ken-

nedy says. “Culture doesn’t change in a day. But already it’s

common in our bed meeting for someone to say, ‘I’ve identified

four discharges, but the forecast says I’m going to have seven.’

Instead of questioning the forecast, they’re looking for what

they might have missed.”

Throughout the day, managers and staff can view patient status

at a glance based on real-time feeds from the electronic health

record and other systems. Late medication orders, pending

lab results or other bottlenecks are identified so they can be

addressed and patients can leave on time. Managers also rely

on the forecasts to adjust staffing, based on whether a unit is

lagging behind expected discharges or getting more admissions

than anticipated.

Discharge targets drive down ALOS

Within nine months of using discharge targets, AnMed Health

shaved a half-day off of average lengths of stay, driving it down

from 4.8 to 4.3, for a 12% improvement. One reason for the

rapid success was staff aiming to meet daily discharge targets

based on data-driven, operational analysis.

“Just knowing those discharge targets motivates staff to proac-

tively think about what needs to happen to get their patients

out of the hospital,” says Kennedy. “Yes, we are fortunate to

have cutting edge technology like Capacity Planner™, but

helping our employees get the information they need to be

successful in the job they do each day is the true benefit.”

Nurse redirects goodwill to serve co-workers

One of Misty Thomas’s patients wanted to reward her for the

work she had done for him as an RN in the Cardiac Telemetry

unit on 5 North. It wasn’t the first time for Thomas; gifts of

cakes or cookies had previously signified a patient’s gratitude

for a job well done, but this was the first time that a patient

attempted to award her with cold, hard cash.

“He was such a nice man and gave me a note telling me not to

open it until he left,” Thomas said, “but finding money with

the note really surprised me.”

In the note, the patient thanked Thomas for making his

stay pleasant, and he included a $100 bill so she could treat

herself to a gift. Although she was flattered, Thomas knew she

couldn’t keep the money despite how much the patient wanted

her to have it. She quickly explained this to the patient and

called a patient care coordinator, who suggested a donation to

the AnMed Health Foundation on her behalf. Thomas knew

immediately she wanted the money to go to the Employee

Financial Assistance Fund.

“There are many great things the foundation does to help

people outside the hospital,” Thomas said, “but I feel like my

coworkers also need help when things go bad for them.”

The AnMed Health Foundation created the Employee Finan-

cial Assistance Fund so people like Thomas can aid their fellow

employees who are enduring a one-time catastrophic event,

whether that comes in the form of a car accident, house fire or

sickness.

Michael Cunningham, vice president for Advancement, said

Thomas’s decision was an excellent example of peer leadership

at the unit level.

“We are thankful for every gift to the foundation, and we know

that this gift in particular came as a result of the excellent care

provided by a valued member of our team,” Cunningham said.

“It’s fitting that Misty also exhibited the same level of caring

for her co-workers and looked for a way help them. We all may

find ourselves in need of help at some point.”

“Our goal is to create the best environment for our nurses and other staff to provide the exceptional care our patients deserve.”

— Bryan Kennedy, M.S., RN, NEA-BC, director medical/surgical nursing


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Certified Nurses 3 North Outpatient Surgery

Lesha Jenkins

4 Center

Gloria Cheek

Kelly Herring

Nancy MacDougal

Dawn Smalley

5 Center Progressive Cardiac Care

Beverly Stewart

5 South

Donna Kleister

6 North

Sunni Busby

Kathy Gibson

Allison Mast

Heather Thompson

Joan Zangas

6 South

Stephanie Brown

Jane Mitchum

Amy Morrison

Melita Pena

7 South

Melisa Aiken

Mary Dugan

Lisa Haynes

8 South

Tandi Gilmore

Allison Morgan

Whitney Sanders

Anesthesiology

Rawhi Abu Abdo

Mark Bone

Michele Buckreis

John Burgess

James Calvert

Adrian Cauley

Nancy Chabek

Joyce Collier

Val Consonery

Bridget Cromer

Shauna Cox

Jesse Kaiser

Kristen Mills

Curtis Moore

Jason Mortenson

Luann Nuttall

Carol Pethel

Greg Sanders

Jesse Smith

Carol Watts

Amy Weaver

Bariatrics

Heather Caldwell

Cath Lab

Stephanie Luper

Centralized Monitoring

Brenda Randolph

CHF Clinic/LifeChoice

Melissa Smith

Clinical Quality Outcomes

Beth Hunt

Freda Kelley

Jody Phillips

Critical Care Unit

Barbara Leaf

Robin Michael

Sharon Smith

Ann Thomason

Marshall Wilson

CV-ICU

Cindy Bradshaw

William Hulme

Laura Kesler

Amanda Snow

CV Services Administration

Kimberly Kamp-Irby Hill

CV Surgery

Erin Evans

Diabetes Education

Thomasena Hunt

Jane Mauldin

Structural EmpowermentEmpowering nurses to accomplish goals


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Emergency Department

Nella Allen

Marie Ashley

Sarah Atkin

David Cothran

Melody DeAngelis

Tara Devido

Nancy Ellett

Katy Guinn

Marcy Holbrooks

Taylor Jones

Paige Kennedy

Joyce Lawless

Teryi Louch

Jamie Moon

Carol Mozingo

Ruth Ricci

Tamme Sanders

Zach Stancell

Stacey Sullivan

Virginia Taylor

Jean Wald

EP Lab

Carla Holmes

Stew Powers

Executive Offices

Tina Jury

Dianne Spoon

Home Health

Shirley Walker

Infection Control

Gwen Usry

Infusion Center

Kat Bachman

Carol Holder

Intensive Care Unit

Sheila Burdette

Melissa Haynie

Cyndi McGee

Cheryl Quartararo

Aimee Sharp

IV Therapy

Urban Hilton

Andrea Ohly

Labor and Delivery

Angie Riddle

Doris Street

Kim Watson

LifeChoice

Amy Goodson

LifeFlight

Jennifer Clark

Jennifer Durham

Angela Fields

Alex Nicholas

Amy Jo Wess

Kids’ Care

Linda Gardner

Cathey McClain

Mother-Baby Unit

Sarah Culclasure

Kendr Powell

Karine White

NSICU

Chuck Horton

Tracy Kopp

Lynn McCarragher

Nursing Staff Development

Annette Drake

Andrea Franks

Darlene Hoyle

Lorri Smith

Shelly Walters

Occupational Health

Ann Burdette

Valerie Mattingly

Connie Simpson

Oncology Research

Penny Argo

PACU

Delores Muhammad

Patient Care Administration

David Abramovitz

Hope Campbell

Paul Hubbard

Bryan Kennedy

Lisa Leary

Patient Safety

Kathy Betsill

Perioperative Services

Lisa Autry

Kim Cameron

Resource Team

Lisa Deptula

Kimberly Hair

Greg Krakos

Mary Marzolf

Misty Patterson

Jonathan Whitfield

Surgery

Melissa Croft

Surgery Assessment Center

Crystal Hooper

Connie Roberts

Women’s and Children’s Hospital Administration

Ashley Stevenson

Cynthia Swaney

Women’s and Children’s Hospital Anesthesiology

Brook Cauley

Charles Flowers

Debora Froese

Christopher Leonard

Anna Mayberry

Deborah Salley

Catherine Schnepf

Shelley Spang

Paul Ward

Women’s and Children’s Hospital Endoscopy

Becky Martin

Women’s and Children’s Hospital PACU

Pamela Griffin

Barbara McAlister

Women’s and Children’s Hospital Pediatrics

Britane Clark

Tiffany Lyon

Jackie Myers

Women’s and Children’s Hospital Surgery

Ann Cothran

Dianne Davis

Erin Keeney

Martha Rush

John Williamson

Women’s and Children’s Hospital Surgical

Cindy Simmons

Women’s and Children’s Nursery

Ann Bolt

Women’s and Children’s Outpatient Surgery

Debra Kelly

B. Sue Smith

Michele Snipes

Melinda Phillips

Wound and Hyperbaric Medicine

Beverly Harris

Barb Mullinax

Wound Care

Kelli Potter

Angela Senkiw

50%

AnMed Health RNs who have a BSN or MSN.

22%

AnMed Health RNs who are certified.

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Nurses earn Peggy G. Deane Scholarship

Four employees earned the Peggy Gardner Deane Scholarship

for nursing education.

The Peggy Gardner Deane Scholarships are awarded each year

to nursing students who have completed at least one semester

toward a BSN or MSN degree. Scholarships are awarded to

qualifying applicants with the highest grade point average and

best answers to why they should receive the awards.

Recipients for 2015 were Danielle S. Fields, Freda A. Brock,

Ashley Smith and Ben Williamson.

Fields is an RN in the operating room. She continued her

education at the Chamberlain College of Nursing in pursuit of

her MSN Executive Specialty. She wants to become part of the

nursing leadership at AnMed Health and to use her degree to

do some missionary work.

Brock is an RN at LifeChoice. She completed a BSN at Grand

Canyon University, and hopes the bachelor’s degree will

further enhance the quality of holistic care given to patients.

She is working on her 36th year with AnMed Health and has

become a licensed pastor in the United Methodist Church.

Smith is a student at Lander University and a PCT on 5

South, where she joined the staff in April 2014. She is working

toward her BSN at Lander University.

Williamson is an RN on 8 South and a member of the float pool/resource team. He is attending the Medical University of South Carolina where he is pursuing a Doctor of Nursing Practice. His goal is to work as a family nurse practitioner in

rural health.

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Nurse goes an extra mile to keep patient well at home

David Ramsey’s wheelchair is his constant companion. It has

kept him moving for 27 years since he was paralyzed from the

waist down. It is his lifeline to mobility.

The chair also can be dangerous for him.

People who spend most of every day in a wheel chair rely on

often unseen technology to remain healthy. Without the pro-

per cushioning, sores can become life-threatening ulcers, and

that’s what happened to Ramsey when his cushion wore out

before his insurance was prepared to buy another one.

He developed a sacral ulcer and was hospitalized with an infec-

tion and other wound care issues. Without a way to replace the

cushion, Ramsey spent much of his healing time worried about

what he would do when he returned home. Valarie Haisley,

RN, CWCN from Wound and Ostomy Care, was concerned

that without a proper ROHO cushion, her patient was at risk

of re-infection, more hospitalizations and even death.

With Shelley Stone of Care Coordination, she contacted

Service Recovery Manager Leigh Freeman, who manages

the Robert B. Claytor Patient Assistance Fund, which then

purchased the cushion for him with the help of the AnMed

Health Home Care showroom staff.

“I don’t know what I was going to do without this,” he said. “I

have been trying to for months to get the insurance company

to replace my ROHO cushion.”

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Leigh Freeman and Valerie Haisley check in on patient David Ramsey, who says the care he has received at AnMed Health over the years has kept him alive.

Patel travels to serve the poor in Nepal

Dhara Patel enjoyed luxuries such as

air conditioning, abundant medical

supplies and adequate lighting as an

RN in 4 Center’s Oncology and Renal

Unit. Not every health care worker in

the world gets to enjoy the things that

some AnMed Health employees might

take for granted, and Patel learned this

thanks to a 17-day externship to Pokhara, Nepal.

“I had always been curious about health care and hospitals in

other countries,” Patel said. “I wanted to see a real hospital in

Nepal and experience what the locals there experience.”

While finishing up her last year at Tri-County Technical

College, Patel had the option to visit a clean, air conditioned

private hospital in Nepal, but opted for one of the poorest

hospitals she could find in Pokhara. Patel had to rely on a

handful of English-speaking doctors and some basic Nepalese

words and phrases she learned for the trip. However, she didn’t

need to be well versed in the native language to see just how

different these hospitals were from those in the United States.

“Unless it was an emergency situation, most patients had to

pay for medication and supplies before a doctor could care

for them,” Patel said. “That didn’t hit home until I noticed a

man who couldn’t afford to pay for his wife, who was suffering

seizures right next to him.”

The hospital had forms poor patients could fill out—dubbed

“poor people forms”—but the processing time involved ren-

dered them all but useless. To Patel’s surprise, the hospital did

maintain some surprisingly modern equipment, such as dialysis

machines that had been donated by international charities.

She also came equipped with a respectable bag of supplies

thanks to the AnMed Health Global Outreach Program. The

program, started by Emily Jarinko and Ann Cothran, supplies

employees like Patel with expired or open and unused medical

supplies. The gauze pads, gloves and other items Patel brought

to Pokhara were a welcome sight to the hospital’s doctors and

nurses.

Patel learned that some aspects of a health care system, such

as an established hospital hierarchy and basic supplies, need to

be in place regardless of geographical location. However, Patel

also learned just how well she and other nurses have it in the

United States, and she doesn’t plan on taking any aspect of her

job for granted anytime soon.

“Even if I’m faced with a difficult day, at least I’m not working

in low light or in 90-degree temperatures,” Patel said. “After

my experience in Nepal I know no matter where I’m put I can

survive it.”

Summer externs benefit from preceptors

AnMed Health welcomed 11 nursing students from Clemson

University, the University of South Carolina and Anderson

University for the summer of 2015. These nurses participated

in AnMed Health’s two-month summer extern program.

Nursing Staff Development paired these externs with nurse

preceptors to increase competence in basic nursing care and

sharpen critical thinking and clinical assessment skills. Many

summer externs stay on as patient care technicians, while

others are recruited for RN positions after graduation.

The nurse preceptors in this program

subscribe to the philosophy of nurses as

teachers, as this program helps nurses

demonstrate their ability to educate

aspiring nurses and potential future

coworkers.

Each year, the externs are asked to no-

minate a special preceptor that has made a significant impact

on their development as a nurse.

Kimberly Abrams


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The Excellence in Precepting the Summer Extern Award is

given out each summer at a ceremony. Kimberly Abrams, an

RN in the ICU, was honored with this award after being nomi-

nated by summer extern Rachel Kunkel.

Baby-Friendly efforts earn $25,000 check

It’s one thing to say that a health care organization will

become “baby friendly” by initiating some changes here and

there, but it’s quite another to actually make those changes a

reality. The AnMed Health Women and Children’s Hospital

has accomplished just that over the past year, becoming the

first upstate South Carolina organization to be designated a

Baby-Friendly USA hospital. But this honor also came with

a $25,000 bonus award simply because of the speed at which

AnMed Health achieved this designation.

“The entire staff of the Women and Children’s Hospital achie-

ved this by changing many processes and focusing on educati-

on,” said Doris Street, manager of Labor and Delivery. “These

changes affect care from the new parents’ first appointment to

well after those parents leave with a baby in their arms.”

Street refers to it as change, but it might as well have been

an evolution for the Maternity Services Department and the

physicians and medical staff associated with it. That kind of

evolution in health care requires changes in seemingly small

processes that end up having a ripple effect on an entire

department.

The biggest changes revolved around an emphasis on skin-

to-skin contact between mother and baby and “rooming in,”

or keeping the baby as close to the mother and father as is

Members of the Women’s and Children’s Hospital maternity services received a $25,000 check for rapidly adapting their services to earn Baby-Friendly USA status.

medically possible in the moments directly after delivery, both

in the case of vaginal birth and cesarean section. Making skin

to skin possible and even commonplace required more effort

than anyone could have realized.

“The physicians and nurses had to get used to an entirely new

variable in the normal routine,” Street said, “but cutting down

what was once a two to six-hour separation to no separation

at all allowed us to make huge strides in giving parents the

needed time to bond with their children.”

The benefits of skin-to-skin haven’t just been emotional, as

many studies have shown that this practice is a preventative

measure against allergic diseases that also leads to a more

stable temperature and heart rate in newborns. Encouraging

mothers to breastfeed their babies so that mother and child

reap the additional health benefits is also a large part of the

Baby Friendly USA criteria.

Street and her staff learned to effectively encourage breastfee-

ding without dictating right and wrong to parents. This change

required the staff to document every instance of attempted

education with prospective parents and complete 20 hours of

education on skin-to-skin contact, breastfeeding and formula

feeding. This type of training will be continuous so that An-

Med Health can maintain its Baby-Friendly USA status.

Street and her staff are grateful to

the parents who were willing to

participate in the trial-and-error

approach that Maternity Services

took to these changes.

“Parents that experienced the ‘old

way’ loved the new policies and

procedures we were implemen-

ting,” Street said. “That alone re-

ally boosted our confidence in what we were doing and showed

us these changes were for the better.”

201317.32%

201418.35%

18%

201522.96%

20%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

Nursing Certification Rate Nursing Certification Goal

Rate

Goal

% o

f N

urse

s

AnMed Health Nurses at All Levels Certification Rates 2013-2015

AnMed Health’s new executive team includes two nurses

A new leadership team took shape at AnMed Health in 2015

as a new CEO put new executives in place and shifted some

responsibilities for others. The executive leadership includes

two nurses.

The changes included promoting Tina Jury, executive vice

president of Patient Care Services and chief nursing officer,

to executive vice president of hospital operations and chief

nursing officer.

Jury has been CNO since 2007 and was

director of medical surgical specialties

before that appointment, and worked for

Bon Secours St. Francis Health System

of Greenville before joining AnMed

Health. She holds bachelor’s and mas-

ter’s degrees in nursing and an advanced

certificate in nursing administration.

Dianne Spoon, who has worked for AnMed Health since 1977,

was named vice president of nursing. She has experience in

critical care, coronary care, med-surg and pediatrics. She has

previously served as nurse manager

of CCU/CVICU and she was the

manager of the unit as AnMed Health

grew and launched an open heart

program. Spoon most recently served

as assistant vice president for Patient

Care Services. She has a bachelor’s

degree in nursing and an MBA, as well

as an advanced certificate in nursing administration.

Tina Jury

Dianne Spoon


Exemp

lary Practice

Preoperative class helps improve weight loss surgery success

A new program is helping bariatric patients continue to lose

weight six months after surgery. The Metabolic and Bariatric

Committee developed and implemented a preoperative be-

havior modification program for patients that bumped up the

percentage of bariatric surgical patients still losing weight after

six months by more than 11 percentage points.

Bariatric patient navigator Heather Caldwell, BSN, RN,

CMSN, CBN, and dietician Jill Fridley, LD, RD, noticed a

lack of sustained weight loss in some patients who had not at-

tended a preoperative behavioral modification class. About 20

percent had stopped losing weight by the time they attended

their six-month postoperative checkup. They expressed con-

cerns to bariatric surgeon Dr. Adam Beall and Hope Campbell,

director of Behavioral Health Services.

With the help of Sarah Fox, Access Center manager for

Behavioral Health, they developed a preoperative behavior

modification class that focuses on mindful behaviors and trig-

gers that are associated with the kind of unhealthy decisions

that impede weight loss. The class is called “Mindful Eating:

Changing Patterns/Behaviors.”

Topics for the class include regulating eating patterns and

behavior, changing patterns and habits, and being aware of at-

titudes toward food. Since the program was implemented, the

percentage of patients continuing to lose weight six months

after surgery rose from 80 percent to 91.3 percent.

A survey of AnMed Health RNs who spend at least 50 percent

of their time in direct patient care revealed several reasons to

celebrate. Results showed nurses have positive feelings about

the adequacy of resources and staffing, including availability

of tools and resources and having the time to provide the best

care; autonomy, including involvement in decision making

and opportunity to influence nursing practice; and funda-

mentals of quality nursing care, including patient safety as a

priority, involvement in quality improvement activities and

nurse leaders sharing a clear vision for how nursing should be

practiced.

Adequacy of Resources &

Staffing

2.80%

3.00%

3.20%

3.40%

3.60%

3.80%

AnMed Health National Nursing Excellence October 2015 Avg

4.00%

4.20%

4.40%

Autonomy Fundementals of Quality

Nursing Care

Interprofessional Relationships

Leadership Access and

Responsiveness

Professional Development

RN to RN Teamwork and Collaboration

ANCC Category Performance Scores

593 RNs Responded

Becker’s Hospital

Review recognized

AnMed Health in 2015 as one of the

100 Hospitals with Great Heart Programs 2015-16.

AnMed Health was ranked by CareChex as one of the top 25

hospitals in the

country for m e d i c a l excellence in cardiac care.

Exemplary Professional PracticeCommitment to the highest standards


Exemp

lary PracticeExem

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ice

The American Heart Association

awarded AnMed Health a Silver

Award as part of its Mission:

Lifeline® program.

AnMed Health honored for resuscitation efforts

AnMed Health received the Get

With The Guidelines® – Resuscita-

tion Silver Award for implemen-

ting specific quality improvement

measures outlined by the American

Heart Association for the treatment

of patients who suffer in-hospital

cardiac arrests in the hospital.

More than 200,000 adults and chil-

dren have an in-hospital cardiac arrest each year, according to

the American Heart Association. The program was developed

with the goal to save lives of those who experience in-hospital

cardiac arrests through consistently following the most up-to-

date research-based guidelines for treatment. Guidelines inclu-

de following protocols for patient safety, medical emergency

team response, effective and timely resuscitation (CPR) and

post-resuscitation care.

AnMed Health received the award for meeting specific mea-

sures in treating adult patients who suffer in-hospital cardiac

arrests in the hospital. To receive this award a hospital must

comply with the quality measures for one year.

“AnMed Health is dedicated to helping our patients have

the best possible outcome and implementing the American

Heart Association’s Get With The Guidelines – Resuscitation

program will help us accomplish this by making it easier for

our teams to put proven knowledge and guidelines to work on

a daily basis,” said Mike Tillirson, executive vice president and

chief medical officer.

“We are pleased to recognize AnMed Health for their

commitment in following these guidelines,” said Deepak L.

Bhatt, M.D., M.P.H., national chairman of the Get With The

Guidelines steering committee and executive director of Inter-

ventional Cardiovascular Programs at Brigham and Women‘s

Hospital and professor of medicine at Harvard Medical School.

“Shortening the time to effective resuscitation and maximizing

post-resuscitation care is critical to patient survival.”

Get With The Guidelines-Resuscitation builds on the work of

the American Heart Association’s National Registry of Cardi-

opulmonary Resuscitation, originally launched in 1999 and has

collected in-hospital cardiac arrest data from more than 500

hospitals. Data from the registry and the quality program give

participating hospitals feedback on their resuscitation practice

and patient outcomes. The data also help improve research-ba-

sed guidelines for in-hospital resuscitation.

Certified Zero Harm awarded in five areas

The South Carolina Hospital Association presented AnMed

Health with Certified Zero Harm Awards in five areas. The

awards were for surgical site infections for knee replacement,

surgical site infections for hip replacement, central line-associ-

ated bloodstream infections for the Coronary Care Unit, cent-

ral line-associated bloodstream infections for the Neurological

Intensive Care Unit, and central line-associated bloodstream

infections for the Cardiovascular Intensive Care Unit.

Certified Zero Harm Awards are given to hospital units that

record no preventable hospital-acquired infections of a specific

nature during a certain period of time. The data is indepen-

dently verified by the South Carolina Department of Health

and Environmental Control.

The SCHA says zero patient harm can be accomplished only

through purposeful, ongoing, collaborative work among physi-

cians, clinical staff and support staff.

5 years of LifeFlight

AnMed Health

LifeFlight celebrated

its 5th anniversary

in 2015. In that time

the program has

earned accreditation

by the

Commission on Accreditation of Medical Transport Systems

and distinguished itself around the state. AnMed Health

LifeFlight was the first in the state with a Lucas CPR device on

board and the first to carry fresh frozen plasma on every call.

AnMed Health falls reduction project scores big

A project undertaken by its Falls Prevention Committee did

better than hoped in reducing the rate of falls with injuries at

AnMed Health Medical Center.

There were 1.18 falls with injury for every 1,000 patient days

in 2014, and the committee established a goal to reduce that

number by 15 percent, with a stretch goal of 25 percent. By

March of 2015 the 25 percent goal had already been reached

and when 2015 ended, even that goal had been exceeded. The

2015 rate was 0.8 falls with minor or greater injuries per 1,000

patient days, a 32 percent reduction.

The project resulted in a new grid in language that is easier to

follow by everyone involved in the care of a patient, including

licensed and unlicensed care givers, and even family members.

The Falls Prevention Committee drew on data from post-fall

huddles to stratify the circumstances of falls with injuries.

Based on their analysis, the committee advocated for repla-

cement bed alarms, a falls prevention fair to improve staff

competencies and a “No-Pass Zone” spearheaded by environ-

mental services and engineering in conjunction with Training

and Organizational Development.

According to Bryan Kennedy, M.S., RN, NEA-BC, director

medical/surgical nursing, the committee realized that most

successful programs to prevent falls are focused more on tying

interventions to risk levels rather than looking at the patient

risk assessment score. Although they originally had plans

for a new risk assessment tool, they put that plan on hold to

focus on building a set of interventions for each risk level.

They wanted to establish intervention guidelines written in a

language that was common to all staff working with a patient,

and not only to nurses.

“One of the satisfying aspects of this

project – and I think the reason it led

to positive results – is that it empowe-

red the front-line staff to promote and

practice safety,” Kennedy said. “Our

committee included nurses, unlicensed

assistive personnel, physical therapists,

dieticians, environmental services

personnel and staff development folks working together for the

good of our patients.”

The committee worked to determine useful interventions

based on the members‘ clinical experiences and on professional

literature. Special attention was given to listing interventions

in plain language, such as using the phrase „anxiety meds“ as

opposed to „benzodiazepines.“ The group avoided phrases like

,if clinically indicated“ since experience had shown assistive

personnel were often the ones implementing the interven-

tions, and should not be responsible for determining those

indications. Instead, each Morse Fall Scale risk level was

assigned must-have interventions.

Kennedy worked with Clinical Educator Andrea Briscoe, M.S.,

RN, CCRN, to obtain feedback from each member. Based on

data showing up to 64 percent of falls were from a bed or chair,

the interprofessional members of the committee felt there

was an urgent need to require chair alarms and bed alarms for

high risk patients. Committee members proved themselves as

patient advocates, pointing out the fact that many patients at

medium risk were generally independent at home and may not

Bryan Kennedy

“One of the satisfying aspects of this project – and I think the reason it led to positive results – is that it empowered the front-line staff to promote and practice safety...”

— Bryan Kennedy, M.S., RN, NEA-BC, director medical/surgical nursing

We’re in this together.ANMED HEALTH


Exemp

lary PracticeExem

pla

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ract

ice

be comfortable with alarms used to prevent them from getting

up. These patients were often a temporary fall risk due to me-

dications and equipment, so the committee agreed that these

patients would be educated on the risk and the interventions

would be determined on a case-by-case basis.

As just one of the results, the final grid shows that patients

at high risk of fall will have bed alarms at all times, but bed

alarms will not be turned on for medium risk patients until

9 p.m. Practices like that one resulted from clinical nurses

identifying and correcting processes that improved the effecti-

veness of the Morse Falls Scale. By involving representatives of

all staff involved in patient care, the committee secured buy-in

from those who will use the new grid.

Ultimately, the committee asked for a sign with color-coded

risk levels that would communicate the required interventions

January

8.80%

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

Vacancy Rate

6.00%

7.00%

8.00%

9.00%

10.00%

Oct-15

7.30%

Nov-15

6.60%

Dec-15

6.70%

Intervention

Pre-Intervention

Post-Intervention

Perc

ent

AnMed Health Vacancy Rateto staff. The new falls intervention grid was designed to serve

as the quick reference that nurses and other caregivers could

use to determine the plan of care.

By focusing on hardwiring current interventions instead of

incurring the costs of a new risk assessment tool, the commit-

tee was able to justify the purchase of additional chair alarms

to support the rollout of the new interventions grid.

The grid was also referenced in the Sentinel Event Alert #55

Response section “Develop an individualized plan of care

based on identified fall and injury risks, and implement inter-

ventions specific to a patient, population or setting.“ The grid

represents a collaborative effort by many disciplines to create a

visual cue which applies not only to professional and unlicen-

sed staff, but enhances the safety of the patients and families

they care for.

Intervention effort addresses staffing shortage

The vacancy rate for nurses had risen to 8.8 percent in 2014 so the Nursing Recruitment and Retention Committee

(NRRC) developed an intervention program. The plan expanded committee participation to include Carlisle Baker,

Human Resources nurse recruiter, and Nedra Brown, MHA, BSN, RN, director of the Orthopaedic Service Line, who

represented nurse leaders.

The two new members of the committee improved communications by serving as great liaisons between the committee, HR

and nursing management and leadership. Many activities were undertaken to address the need for more nurses throughout

AnMed Health.

By October 2015, AnMed Health saw a decrease in the clinical nurse vacancy rates as a result of the recruitment efforts by

the NRRC. Some of the newly hired graduates were from Anderson University, Lander University and Clemson University.

By December, the vacancy rate was 6.7 percent.

AnMed Health hired 94 nurses with bachelor’s degrees in nursing in 2015, a 64 percent increase in BSN hires over the

previous year. The BSN rate overall increased from 48.65 percent in 2014 to 53.25 percent in 2015.

The Nursing Recruitment and Retention Committee launched efforts to reduce the vacancy rate after numbers peaked in 2014.


New

Kn

ow

ledg

e

Nurses lead a variety of research efforts

Fourteen nursing research projects were initiated or underway

during 2015. Six new projects were approved by the Institution

Review Board and four others were closed.

During January and February of 2015, the Nursing Research

Council assisted with the distribution and collection of nursing

and patient surveys for the nursing research project which

validated the AnMed Health Professional Practice Model. In

all, 240 questionnaires were returned from clinical nurses, and

94 surveys were returned by AnMed Health patients.

The 5th annual AnMed Health Nursing Research Showcase

was sponsored by the Nursing Research Council on May 6 at

the AnMed Health Women’s and Children’s Hospital and on

May 7 and 8, at the Medical Center. Fifteen posters were dis-

played on nursing research, evidence-based practice, and quality

improvement projects. More than 100 AnMed Health emplo-

yees attended the showcase, 79 of which were registered nurses.

During the Nursing Research Showcase, the Nursing Research

Council asked the clinical nurses to submit research topics that

they felt needed to be investigated at AnMed Health.

The top five most-frequently mentioned topics were discus-

sed by the Nursing Research Council. The topic included

whether a “safe sleep contract” would help prevent parents

from sleeping with their babies; what percentage of patients

use their Universal Medication Form or discharge teaching

information after discharge; expanding a COPD Transition of

Care project on one unit to all units to improve re-admission

rates; comparing the length of stay for patients for orthopaedic

patients that receive Exparel compared to those who received

a femoral nerve block during surgery; and the effect of the

Healthy Outcomes Plan on low-income patients and families

in Anderson County.

The council members selected the Healthy Outcomes Plan for

further investigation.

Research underway at AnMed Health includes:

• Comparison of Effect of Anesthesiologist and Nurse

Administration of Epidurals on Birth Outcomes.

• Regional Psychiatric Services at Patrick B. Harris

Psychiatric Hospital.

• Investigating the Impact of Baby-Friendly Environment

on Breast Feeding Compliance.

• Presence and Effect of Noise on Medical Surgical Units.

• Use of an Absorbent Soft Silicone Self-Adherent

Bordered Foam.

• Dressing to Decrease Incidence of of Hospital-Acquired

Heel Pressure Ulcers in an Acute Care Setting.

• Investigation of Nurses’ Preferences Related to

Medication Storage.

• Does Distraction Training of Parents Affect Perception

of How Child’s Pain was Managed?

• Validation of AnMed Health Nursing Professional

Practice Model.

• National Database of Nursing Quality Indicators Work

Around Study.

• Risk Factors for Falls in Hospitalized Dementia Patients.

• An Investigation on Inhalation of Lavender Essential

Oil Reducing Acute Post-Operative Pain After

Hysterectomy.

• Maternal Hospital Experiences Associated with Exclusive

Breastfeeding at 2 Months Postpartum.

• Assessment of Nursing Compliance with Intravenous

Line Capping.

• Improving Resuscitation Outcomes at AnMed Health

Using the Resuscitation Quality Improvement (RQI)

Program.

New KnowledgeFinding new and better ways to care


New

Kn

ow

ledg

eNew

Kn

ow

led

ge

Articles published in professional publications

Three articles were pub-

lished by AnMed Health

nurses in 2015.

An article authored by

five Sunni Busby, Bryan

Kennedy, Stephanie Da-

vis, Heather Thompson

and Jan Jones was

published in the May

edition of “Nursing2015.”

The article was entitled “Assessing Patient Aware-

ness of Proper Hand Hygiene” and was based on research the

group completed at AnMed Health in 2014.

A second article based on the same hand hygiene research was

published in the September edition of “Nursing2015 Critical

Care.” The article was entitled “Patients’ Perceptions of Proper

Hand Hygiene.”

An article by Bryan Kennedy and Tracy Kopp was published in

the August edition of “Nursing2015.” The article describes the

results of the Safe Patient Handling Project at AnMed Health

and was entitled “Safe Patient Handling Protects Employees,

Too.”

Research project presented in Puerto Rico

A nursing research project conducted by three AnMed Health

nurses and the Nursing Research Council was presented at the

26th International Nursing Research Congress in San Juan,

Puerto Rico, on July 27, 2015.

Darlene Amendolair and Kathy Betsill made the podium

presentation entitled “Assessing Staff Nurses’ Engagement

with the Professional Practice Model Four Years after Imple-

mentation.”

The results of the study support the idea that AnMed Health

nurses have internalized the concepts of the Nursing Professi-

onal Practice Model. Therefore the current model provides a

visual framework for addressing the essential characteristics,

values and performance expectations of the nurses.

The Nursing Professional Practice Model supports the com-

mitment of AnMed Health nurses to the profession and guides

them in what they do, why they do what they do and how they

do what they do. These study results effectively support the

ANCC Magnet Recognition program by demonstrating that

nurses can communicate the practice model and define how it

relates to their patients and patient outcomes.

Posters shared at four conventions

Nurses from AnMed Health presented posters at four nursing

conventions in 2015.

The RNs from the AnMed Health Wound Care Team presen-

ted findings from their research project on the prevention of

hospital-acquired heel pressure ulcers with a poster presentati-

on at three nursing conferences.

Valarie Haisley and Kelli Potter presented the poster enti-

tled “An Ounce of Prevention: The Use of a Soft Silicone

Five-Layer Bordered Foam Heel Dressing to Decrease the Inci-

dence of Hospital-Acquired Heel Pressure Ulcers in the Acute

Care Setting” at the 47th annual Wound and Ostomy Care

Nurses’ National Convention on June 6-10 in San Antonio,

Texas.

Jamie Wallace and Robin George presented the poster at the

Southeast Region WOCN Society Annual Conference on

September 10-12, in Orlando, Florida.

Valarie Haisley presented a poster at the South Carolina

Nurses Association State Convention on Oct. 22-24, in

Greenville.

A poster describing the Transitions of Care Program for COPD

Patients to Reduce Readmissions was presented by a team from

AnMed Health at the 2015 ANCC National Magnet Confe-

rence in Atlanta, Georgia.

COPD Transitions of Care to Reduce Readmissions

AnMed Health Medical Center, Anderson South Carolina

PROJECT SELECTION

IMPLEMENTATION

OUTCOMES

RESOURCES

Sarah Markel MHA, RRT

Quality Coordinator, Respiratory Care Services

AnMed Health Medical Center

800 North Fant Street

Anderson, SC 29621

864-512-1311

[email protected]

FOR MORE INFORMATION

David Cothran MS,RN,NEA-BC Paul Hubbard MBA,BSN,RN,NEA-BC Sarah Markel MHA, RRT Wanda Perry MEd, RRT Dianne Spoon MBA,BSN,RN,NEA-BC

GOAL

20.2% 18.8% 13.7%

US Average

US Top 10%

0%

5%

10%

15%

20%

25%

20132014

2015 YTD

COPD Discharges Readmitted within 30 Days

AnMed Health Medical Center

Source: Midas

US average & Top 10% from SCHA Readmission Report

(Hospital Compare Q4 2014 release)

Additional Results08/08/14 – 06/13/15

• 396 Patients in the Program

• 1089 Home Visits Completed

• 301 Phone Calls Completed

• Operational Costs: $43,678

• 77 Readmissions Avoided (Estimated)

• Cost Savings: $603,122

Decrease the 30-Day COPD

Readmission Rate by 20%.

( From 18.8% to 15%)

Identify Problem

- COPD was the 3rd leading cause of death in the US in 2011

- COPD noted to be one of AnMed Health’s top 5 DRG with readmission

reduction opportunity

Planning – Methods - Strategies

- Multidisciplinary Team formed to develop readmission reduction plan

1. Brainstorming

• Analyze current situation:

• Timeframe of most readmissions – by day 5 post discharge

• Largest population of readmissions come from the home setting

• Common reasons for readmission

• Medication management, polypharmacy

• Issues with equipment

• Understanding and managing disease symptoms

• Potential solutions:

• Improved patient education process

• Post-discharge contact with patient – in-home, phone

2. Review Best Practices

• Literature reviews

• Patient education materials and methods

• Treatment pathways

• Consult with other organizations to review their initiatives

3. Finalize Project Tools

• Patient identification and readmit risk evaluation tool

• Personalized COPD Action Plan

• Post-discharge home visit and phone call schedule

• Clinical Health Coach Team identified (RN, RT, or Paramedic)

• Standardized in-home and telephone evaluation tools

• COPD Help Line

• Emergency Department alert system for readmits

• Midas database for patient data collection and analysis

4. Implementation Strategies

• Clinical Health Coach education and training

• Communication strategies: memos, presentations, posters, email

• Internal Stakeholders

• Attending physicians (hospitalists, residents, pulmonologists)

• Emergency Department Physicians

• Nursing, Care Coordination, Respiratory Therapy, Pharmacy

• External Stakeholders

• Primary Care Physicians

• Home Health Providers

5. Review and Refine

• Review MS-DRGs of patients in database to evaluate accuracy of

identification and evaluation tool

• Inclusion of patients discharging to AnMed Health Rehabilitation

Hospital

• Root Cause Analysis for program patients readmitted within 30 days

Identify High Risk Patients

• Airway disease severity (spirometry)

• Symptom severity

Assess for Potential Discharge

Needs / Gaps

• Multidisciplinary team

• Includes medication and

transportation assistance as needed

Personalized COPD Action Plan

& Education

• Teach-back method used

• Faxed to Primary Care Physician and

Home Health Provider at discharge

Post Discharge Health

Coach Visits

• 3 in-home visits

• 1 follow-up phone call

• Access to COPD Helpline

Common Issues Identified During Home Visits:

• Medication Organization (pill organizers and set-up provided by Health Coach)

• Problems setting up or using equipment (spacers, oxygen, BiPAP, glucometers)

• Environmental triggers (dander, dust, secondhand smoke)

• Transportation to follow-up appointments

• Social issues

• Difficulty “navigating the healthcare system”

COPD Foundation. COPD Foundation Pocket Consultant Guide. 2014

edition.

Global Initiative for Chronic Obstructive Lung Disease. Global Strategy

for the Diagnosis, Management, and Prevention of Chronic Obstructive

Pulmonary Disease. Updated 2014.

Rennard, et al. Improving the COPD Foundation Guide for Diagnosis and

Management of COPD, Recommendations of the COPD Foundation.

Journal of Obstructive Pulmonary Disease. 10:378-389, 2013.

AnMed Health 5th Annual Nursing Research Showcase

Wednesday, May 6-‐Friday, May 8, 2015

2015 Posters

*  AnMed Health Professional Practice Model

Validation Study-D.Amendolair,Ph.D.,MN,MA,RN and

AnMed Health Research Council

*  Noise Level Research Project on 4 South, 5 South,

and 6 South-A.Drake,BSN,RN, D.

Amendolair, ,Ph.D.,MN,MA,RN, J. Whitfield,BSN,RN, R.

Transue,RN, and Barbara Gordan, RN

*  An Ounce of Prevention: Use of a Soft Silicone, Five

Layer, Bordered Foam Heel Dressing to Decrease the

Incidence of Hospital Acquired Heel Pressure Ulcers

in an Acute Care Setting- V. Haisley,BSN,RN,CWCN,

K. Potter,BSN,RN,CWON-CFCN, J. Wallace,BSN,RN, R.

George,BSN,RN and K. Betsill,MS,RN,NE-BC

*  The Use of a Foam Dressing as an Alternative

Central Venous Catheter/Peripherally Inserted

Central Line Dressing-V.Haisley,BSN,RN,CWCN and

K. Johnson,MSN,MBA,CRNI,VA-BC

*  Baby Friendly Practices and Breastfeeding

Outcomes-E. Cribb, BSN,RN,CLC

*  Does Lavender Oil Aide in the Reduction of

Postoperative Hysterectomy Pain?-C.

Hornbeck,BSN,RN

*  Training Parents to be Distraction Coaches for their

Child during Painful Procedures-T. Lyon,RN and A.

Stevenson,BSN,RN

*  Nursing Evidence-Based Practice and Research

Internship Information Poster-K.Betsill,MS,RN,NE-

BC *  Review and Evaluation Faith-Based Weight

Management Interventions that Target African-

American Women-S. Timmons,Ph.D.,RN

*  STABLE Action Plan at AnMed Health LifeChoice-

M. Swaney,RN

*  Safe Patient Handling and Mobility Program

Outcomes-S. Smith,MSN,RN,NE-BC

*  COPD Transitional Care Program-S. Markel,

MHA,RRT and COPD Transitional Care Team

*  Metabolic & Bariatric Surgery Program Outcomes-

H. Caldwell,BSN,RN

*  Using Capacity Planner to Improve Nursing

Efficiency-B.Kennedy,MS,RN,NEA-BC,

S.Smith,MSN,RN,NE-BC, and P. Davis

*  Joint Commission Transforming Healthcare

Initiative: Reducing Heart Failure Admissions and

Re-admissions-K. Deloplaine,MSN,RN,

M.Gibson,MS,RN,NE-BC, and Heart Failure Initiative

Team


Emp

irical Ou

tcom

es

Pilot program autmatically mea-sures hand hygiene compliance

AnMed Health is one of a half-dozen hospitals nationwide

piloting innovative technology to automatically measure hand

hygiene participation. Hospitals are looking for new methods

to improve participation and better ones for both tracking and

reporting compliance.

In the area involved in the pilot program, the Medical Center

captured more than 100,000 hand hygiene opportunities and

hand hygiene participation doubled in the first 60 days of the

project.

“We have a strong infection control program at our hospital,

and part of the reason is that we are continually looking for

new ways to improve healthcare quality and safety,” said Bryan

Kennedy, director of nursing for Medical/Surgical at AnMed

Health.

“The way so many hospitals collect data is with secret shoppers

or observation,” Kennedy said. “Nurses often know they are

being watched and subsequently show high rates of compli-

ance. The results of this pilot show there’s a more reliable and

efficient way to collect data and to use our resources.”

Health care associated infections, many preventable by proper

hand hygiene, are a continuing challenge in health care.

According to the Centers for Disease Control, one in every 25

U.S. patients will contract an infection at a hospital, accoun-

ting for approximately 75,000 deaths in 2011 and costing $40

billion annually. The CDC estimates hand hygiene complian-

ce rates are at approximately 40 percent nationwide.

AnMed Health piloted the SafeHaven™ automated hand

hygiene system on 6 North Adult Medical. The system features

Georgia-Pacific’s smart hand hygiene dispensers embedded with

Versus Technology Inc.’s Real-time Locating System (RTLS)

technology. The system was installed by VT Group Healthcare

Atlanta’s office, a certified Versus System Integrator.

The system knows which staff members enter a patient room

and whether or not they exercise proper hand hygiene within

30 seconds.

Pain management research project helps dull the ache

Aimee Sharp knows from personal experience how difficult

it can be to watch a child receive a painful shot or procedure.

That knowledge is evident when Sharp describes watching

her own child receive a series of four routine shots, but it also

makes it clear that sometimes the parent’s perception of their

child’s pain is a bit different from reality.

“I was a nervous wreck for an hour, but my daughter cried for

half a minute,” Sharp said. “It was clear that she had ‘moved

on’ once the nurses gave her a jewelry box to play with.”

When Sharp became the nurse manager for pediatrics in May

2014, she felt like pain scores in the unit could be improved.

Although 3 West was already using music therapy to distract

and calm patients experiencing pain, Sharp felt the staff could

do more. She credits two of her nurses, Ashley Stevenson

and Tiffany Lyon, for taking this work and running with it, so

much so that both nurses undertook a research project appro-

ved by the IRB that will shed more light on the relationship

between a parent’s perception of pain and the care the child

receives.

Empirical OutcomesMeasuring results to know what works


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The staff now uses a four-pronged approach to improve pain

scores. Pediatric-friendly IV bags make instruments look “less

institutional.” Nurses use pain ease spray to numb areas for

shots and lab draws. However, the most effective tool in the

nurse’s bag has become “Buzzy Bee,” a mascot of sorts that

doubles as a tourniquet. Buzzy resembles a bee, but its wings are

ice cold to numb pain and its belly vibrates when kids touch its

head, which creates just enough of a diversion. The unit is also

using iPads with different apps that don’t just act as a distracti-

on for kids.

“These things help to distract parents as well,” Sharp said.

“We’re teaching parents to be ‘distraction coaches.’”

Parents are the ones filling out post-visit surveys related to

their children, so the research of Stevenson and Lyon revealed

a great deal about a parent’s perception of pain. Stevenson

said pain scores have improved overall in the unit and she and

Lyon are now using a video entitled “How to be Distraction

Coaches” with parents that makes them feel like they’re part of

the process and not helpless spectators.

“We will have happier patients and families,” Stevenson said.

“We also hope this shows how much we value and care about

our patients and families.”

AnMed Health team honored with Touchstone Awards

Two teams from AnMed Health earned accolades at Caro-

lina Healthcare System’s Sixth Annual Quality and Patient

Experience Sharing Day. CHS held the event to recognize

innovative projects from clinical and non-clinical teams from

CHS facilities across North and South Carolina.

A multidisciplinary team of 17 AnMed Health employees

earned a Bronze Touchstone Award for improvement efforts to

decrease surgical site infections. Aside from mitigating finan-

cial losses, a reduction in surgical site infections would reduce

pain for patients and the length of hospital stays.

“Surgical site infections come at a great cost to both hospital

and patient,” said Gwen Usry, Infection Prevention coordina-

tor. “Reducing these infections makes a positive difference in

the health of the patient and for AnMed Health as an organiz-

ation serving that patient.”

The team identified interventions at every phase of surgery,

including in the operative suite and during during pre- and

postoperative care.

Surgical site infection rates decreased 14.5 percent between

2012 and 2013. The following year, the rates plummeted

by 23.4 percent. The team estimated that the project saved

AnMed Health almost $400,000, but more importantly it

prevented over 200 days of inpatient care.

Another team from AnMed Health earned a Silver Touchs-

tone Award for the COPD Transitional Care Pilot Program.

The program, spearheaded by Respiratory Quality Coordinator

Sarah Markel, sought to reduce 30-day readmission rates for

COPD patients.

“Patients have a better chance of staying home where they are

comfortable, and AnMed Health avoids Medicare penalties for

re-admissions,” Markel said. “The program truly improves the

patient experience while saving money.”

Markel, along with Wanda Perry, Dianne Spoon, Paul Hub-

bard and David Cothran, began research on the program in

May 2014 before it went live on Aug. 18, 2014. By using exis-

ting resources conservatively, Markel and the team developed

personalized COPD action plans for patients and established a

COPD help line and clinical health coach team.

After implementation, AnMed Health’s re-admission rates for

COPD patients dropped from 20.2 percent to 13.7 percent,

putting the organization safely within the top 10 percent of

hospitals in the nation and resulting in a cost savings of more

than $600,000. Markel is now working with AnMed Health

and CHS to extend this program to other chronic diseases.

Glyemic control program improves numbers in patient population

The staff of 7 North and Neuro ICU was the final and most

frequent winner of a quarterly contest to improve blood

glucose numbers for patients. The goal of the effort, called

Step in Line with 179, was to reduce the percentage of patients

with readings greater than 179 mg/dl after the first 24 hours of

admission.

Before the contest

started, about 33-35

percent of inpatients

would exceed 179

after 24 hours. Al-

though the quarterly

contest ended, the

program is ongoing.

The objective of the

program was to bring

the average to less than 28 percent. AnMed Health finished

2015 with an average of only 22.8 percent of patients excee-

ding the mark.

Improving glycemic control will truly make a difference in our

patient care outcomes since hyperglycemia can increase the

risk of infection, impair wound healing, increase blood clots

and renal failure, increase ventilator days, worsen congestive

heart failure and pneumonia and increase disability following

heart attack and stroke, said Jane Mauldin, diabetes education

manager.

The staff at 7 North and Neuro ICU celebrates winning the quarterly Step in Line contest.

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