Editor: Jody Schipper, MSN, RN
Professional Development Coordinator
Deadline for article submission is the 5th of each month
Allen Nurse Presents at University of Iowa EBP Conference
As you may remember, the Buzz featured the work of Denise Lundberg and the Evidence-Based Council in January. Click here to read the original article. Denise reviewed the evidence supporting the elimination of heparin for central line flushes and successfully implemented a practice change at Allen.
Denise presented Anti-Reflux Devices on Central Lines at Allen Hospital as a poster presentation at the 18th National Evidence-Based Practice Conference hosted by the University of Iowa. The theme of the conference this year was Connecting with Consumers for Evidence-Based Health Care. The conference was held April 28-29, 2011.
Congrats to Denise and the EBP Council. Great job bringing research into practice!
Deanne Ambroson and Denise Lundberg with the poster presentation.
Members of the Evidence-Based Practice Council attended the event to show their support.
From L to R: Rita Borrett, Katherine Krukow, Cindy Jenness, Denise, and Molly Black. Not pictured: Angie Sampson.
We continue our review of Allen’s Shared Governance Councils with a look at the Evidence-Based Practice (EBP) council.
The purpose of the EBP Council is to bridge the gap between research and practice. The council is responsible for:
Review current research and literature pertinent to the practice of nursing.
Promote and facilitate EBP at the unit level.
Convey EBP issues from units.
Review all nursing research requests. Coordinate review with Ethics Committee.
Develop, revise, and disseminate clinical nursing standards, including standards of care
and standards of nursing practice.
Develop nursing policies, procedures, and protocols for the nursing department.
Collaborate with Professional Life Council to implement standards, policies, procedures,
and protocols for education and plan for implementation.
Represent nurses as an integral part of Allen Health System.
Recently the EBP Council has worked to develop or update various policies/procedures such as the Foley, MEWS, Tube Feeding, NG, and Biopatch protocols.
Talk to your EBP representative for more information!
Angie Sampson, 3 Surgical (chair)
Gale Carlson, MHU (secretary)
Molly Black, 3 Medical
Connie Boelman, Surgery
Crystal Dailey, 3 Heart
Will Evans, ICU
Katherine Krukow, 4 Tower
Kimberly Neuhaus, Resource
Dennis Preuss, Infusion Services
Theresa Pierce, 4 Ortho
Marsha Haugen, CNS Oncology and Palliative Care
Michelle Heine, Infection Control
Deanne Ambroson, Allen College
Lori Murphy-Stokes, Director Representative
Rita Borrett, Nurse Manager Representative
7/22 BLS Renewal
7/28 End of Life: Symptom Management
8/3 Refreshing your Preceptor Skills
8/4 BLS Renewal
8/5 Nonviolent Crisis Intervention – Refresher
8/9 Respirator Fit Testing
8/17 Nonviolent Crisis Intervention
8/17 Preceptor Development
8/18 BLS Renewal
IV Medication Mix-Up
Chris Clayton, Pharm. D., MBA - Director of Pharmacy/Patient Safety Officer
A recent medication error occurred that I want all of you to be aware of as it could happen to anyone and potentially be life threatening to a patient.
Two IV medications were being infused through a dual pump, one med hanging on the left side and another on the right side, with the pump correctly programmed according to left and right. The issue was that the IV lines got crossed so that the IV medication on the left side was routed through the right side of the pump and the IV medication on the right side was routed through the left side of the pump. As one can imagine, depending on the medications being delivered and the rates of administration this could lead to a very serious outcome.
What needs to happen right now is awareness of this potential situation and making sure that during bag starts, bag changes, and hand-offs that the IV line be traced down through the pump to assure the IV medication is indeed being administered with the correct pump settings. There is more to learn from this opportunity and additional ideas and considerations are being discussed. There will be more communication coming in the near future regarding any policy or procedure changes.
If you have questions please contact me at 235-3660. Thank you.
Welcome New Nurses
From L to R: Kelsie Graham, 3 Heart; Emily Stark, ICU; Trisha Knipper, Resource; Nicole Glawe, 3 Medical; Terry Wagner, Resource
Net Learning Email Reminders Coming Soon
We are in the early stages of setting up email reminders for classes you have registered for in Net Learning. We will begin testing the email notices in the coming weeks. If you are interesting in receiving email notifications for classes in which you are enrolled, you must first enter your email address in the Net Learning Student Interface. Here’s how:
1. Log in to Net Learning as you normally do.
2. Click the “email” link next to your name at the top of the page.
3. Enter your full email address in the space provided.
4. Click Save.
5. You will see a message that says “changes saved successfully”. You will also see
that the email address you entered is now displayed at the top of the page next to
Again, we are just beginning the process with Net Learning. However, we hope to have email notifications functioning by the end of the summer.
You will not receive notifications unless you enter your email address in the Net Learning Student Interface.
| Deb Schilling, RN, CL4, 3 Medical
Deb writes the patient’s designated co-learner on the white board in the patient room.
Tami Burke, RN, 3 Medical
Tami enjoys reading and spending time with her kids.
Merri Koch, RN, 3 Heart
Merri is busy pursuing her BSN. In her spare time she enjoys gardening and baking.
||The whiteboard in the physician workroom on 3 Heart B tracks the patient’s progress toward discharge. CHF patients are flagged on the board and additional measures are tracked such as a scheduled follow-up appointment, the discharge plan, and education performed.
Reducing Readmissions Initiative Update
Jody Schipper, MSN, RN, Professional Development Coordinator
This month we take another look at Reducing Readmissions. In February, the Buzz introduced the initiative in its early stages. Now 5 months into the work, the group is in full swing with a lot of exciting changes to report.
As you may remember, Iowa Health System launched an initiative in January 2011 to reduce avoidable hospital readmissions. The term readmission refers to an admission into the hospital within 30 days of a previous admission. Allen Hospital has targeted Heart Failure and Pneumonia diagnoses. The Allen team consists of multiple disciplines and is focused on two units, 3 Heart and 3 Medical. In addition to Allen associates, the team also includes patients and community representatives, such as home care, physician offices, long term care, and skilled nursing facilities.
Why is this important?
Avoidable hospital readmissions are costly in many ways. They are physically and emotionally challenging for the patient and financially burdensome to the health care system. Furthermore, evidence supports that many readmissions can be avoided (Institute for Healthcare Improvement [IHI], 2011).
What are we doing?
The Institute for Healthcare Improvement has identified four key components needed for a successful transition home (IHI, 2011). The Allen team uses the IHI initiatives to guide their work and great strides have been made to address each of them. Here are just some of the things the group is working on.
IHI Initiative 1: Perform an enhanced assessment of post-hospital needs
Patients on the trial units (3 Heart and 3 Medical) are screened on admission to identify those individuals at an increased risk for readmission. If the patient is deemed high risk, the High Risk for Readmission order set is placed by the admitting nurse. This order set triggers automatic referrals to Case Management, Social Services, Dietary, and Pharmacy.
Throughout the patient stay, the caregivers participate in a multi-disciplinary “discharge huddle” each day. The huddle includes the nurse manager, primary nurse or charge nurse, the hospitalist nurse practitioner, case management, social services, and pharmacy. The group tracks progress toward discharge on a white board in the physician workroom near the nurses’ station. They ensure all discharge needs are identified and addressed early in the patient stay.
IHI Initiative 2: Provide effective teaching and facilitate enhanced learning
Upon the patient’s admission to the unit, they are asked to identify a “co-learner”. The co-learner is considered a partner in the learning process. They should be present for all teaching throughout the stay, especially the discharge instructions. Once the co-learner is identified by the patient, the nurse will contact the co-learner to explain the requirements of the position and gain verbal consent to participate. The co-learner’s name is then written on the patient white board so all staff know who must be present for education sessions.
Teach-back is a key tool in patient education. The term teach-back refers to the patient’s ability to restate the information in their own words. Staff have recently completed a Teach-back Competency and are using teach-back with all educational opportunities.
The group has also worked to standardize written patient education materials. The diagnoses of Heart Failure and Pneumonia now have a “zones” sheet. The zones use reader-friendly/health literate principles to provide a useful reference for the patient to use at home. Click here to view the Heart Failure and Pneumonia Zones.
IHI Initiative 3: Provide real-time handover communications
Several measures are currently being trialed to improve handover communication. The hospitalist nurse practitioners call report to the primary physician upon discharge. Michele Friedman, Hospitalist Nurse Practitioner and Reducing Readmissions Team Lead, has worked with the transcriptionists to develop a process to improve accessibility to the discharge summary. Michele dictates the summary which is then immediately transcribed, printed to the floor, and given to the patient at discharge. A copy is also sent to the primary physician and/or receiving agency. The group has also revised the electronic transfer form and will begin trialing the use of that instead of the paper transfer form in the near future.
IHI Initiative 4: Ensure timely post-hospital care follow-up
Research shows that most readmissions occur within the first 2-5 days after a hospitalization (IHI, 2011). Yet historically post-hospital follow-up appointments are scheduled for 2 weeks post-discharge. These patients must be seen quickly after discharge to ensure a smooth transition home. The group has worked to schedule all follow-up appointments within 2-3 days after discharge. This appointment is scheduled at the time of admission to the hospital to prevent difficulties with either a weekend discharge or a full schedule at the receiving physician’s office.
What are the nurses saying?
Nurses Tami Burke, 3 Medical, and Merri Koch, 3 Heart are members of the Reducing Readmissions team. They are both heavily involved in trialing the tests-of-change on the units. “The new patient education materials, the Zones sheets, are nice. Patients seem to like them”, says Tami. Merri agrees, “The key is to have the patient involved. I tell them to put this sheet where they will look at it every day.” Merri also states the daily discharge huddle has been valuable. “Every day we page overhead when the huddle begins. The team members come together to talk about what the patient needs; what has already been done and what needs to be done yet before discharge. It keeps us all on the same page” she says.
The team continues to seek ways to improve the discharge process and ensure a smooth transition of care. Team members will soon perform observations at area long term care and skilled facilities to learn about their receiving process. “We need to understand the needs of the receiving facility to ensure that we provide the correct information to them. This will, in turn, result in better care for the patient” says Michele Friedman.
Nice job everyone! Keep up the great work!
Institute for Healthcare Improvement (2011). http://www.ihi.org/ihi