S T. L O U I S C H I L D R E N ’ S H O S P I TA L ANNUAL REPORT NURSING 2010 ABOUT US 2 x 2010 ANNUAL REPOR T On the cover: Mary Beck, BSN, RN, CPN, provides care for patients like Conner Rhodes on the Hematology/ Oncology Unit. ST. LOUIS CHILDREN’S HOSPITAL x3 Founded in 1879, St. Louis Children’s Hospital (SLCH) is the oldest pediatric hospital west of the Mississippi River and the seventh oldest in the United States. The hospital has served patients from all 50 states and nearly 60 countries. SLCH has been recognized by Parents magazine as one of the top ﬁve children’s hospitals in America. The magazine names SLCH third in the nation in orthopedics, third in neonatology, fourth in pulmonary, fourth in emergency services and sixth in cardiac surgery. The hospital also is on the U.S.News & World Report Honor Roll of America’s Best Children’s Hospitals. SLCH was redesignated in 2010 as a Magnet® hospital for nursing excellence by the American Nurses Credentialing Center. To date, only about two percent of the nation’s 5,000 hospitals have achieved redesignation. SLCH is the world leader in pediatric lung transplantation, and has performed more than 300 lung and heart-lung transplant procedures. One of the top transplant centers nationally, the hospital has active programs in transplant for heart, liver, kidney, lung and bone marrow. 250 Licensed Beds 3,044 Employees 1,082 Nurses 771 Physicians 184 Residents/Interns/Fellows 87 Advanced Practice Nurses 9.21 Nursing Average Years of Service 9.3% Nursing Turnover Rate .9% Nursing Vacancy Rate 1,187,391 9,105 Visits to StLouisChildrens.org Visits to the Nursing Section of StLouisChildrens.org Contents 6 Transformational Leadership 2010 UTILIZATION 10 Structural Empowerment 15,615 Admissions 12 Exemplary Professional Practice 75,583 Patient Days 16 Process Improvement 18 New Knowledge 12,189 OR Cases 22 Building Systems of Safety 51,242 Emergency Visits 26 By the Numbers 215,392 Outpatient Visits 207 Average Daily Census 79 Transplants 274,792 Total Visits 4 x 2010 ANNUAL REPOR T From Peggy NURSING EXCELLENCE Shared Leadership redeﬁnes teamwork I am pleased to present this 2010 annual report for St. Louis Children’s Hospital nursing and patient care services. I continue to be amazed and proud of our team, who take exemplary care of our patients and families while providing an outstanding learning environment for students and medical trainees. The culture at St. Louis Children’s Hospital is one that is admired by everyone who enters our doors, and each staff member contributes to that in their interactions with patients, families and each other. Despite many past accomplishments, we continue to work to improve the experience for our patients and families, as well as the safety and effectiveness of the care we provide. The launch of our new Shared Leadership model, with interdisciplinary councils for Patient Safety, Clinical Practice, Performance Improvement, Education and Professional Standards, has been particularly gratifying to watch. Front line staff from all of our clinical departments have come together in new ways to discover the joys and opportunities created by teamwork. In this report you will read about some of their accomplishments in this ﬁrst year. Deeper understanding of each other’s’ roles is leading to improved communication and is helping us to remove some of the barriers to creating a Superior Patient Experience. New guidelines for professional presence are helping to create shared expectations for our appearance, behavior and professional relationships with patients and families. While our professional, caring culture is already strong, our staff have identiﬁed some more speciﬁc standards for how we “show up” in our roles at St. Louis Children’s Hospital. This is an exciting example of what can happen through Shared Leadership. Front line staff are determining the image they want to present to our families and how they will manage this with each other. Managers and directors are supporting this conversation, not leading it, and we will see how our culture takes in these new ideas as the discussion evolves. I am conﬁdent it will ultimately make St. Louis Children’s Hospital even more impressive! In a year when the Institute of Medicine and Robert Wood Johnson Foundation published a report on The Future of Nursing calling for us to achieve 80 percent baccalaureate preparation for nurses by 2020, it was gratifying to see that further formal education and specialty certiﬁcation continue to be strong values in our organization. We now have 65 percent of our staff nurses BSN-prepared, with many more in school working toward either a BSN or a graduate degree. In addition, we have 34 percent of our total nursing population certiﬁed in a specialty area, up from 24 percent last year. We also trained 10 additional Evidence-Based Practice (EBP) Scholars, so that we now have at least one on every patient care unit. Several of these scholars have gone on to develop research studies out of their EBP projects, where a gap in the science of nursing practice was identiﬁed. All of this assures that our patients receive care from nurses who are knowledgeable, well-educated and specialized in pediatric care. It was another busy, exhilarating year with many accomplishments. It is a pleasure to serve as a leader for staff who strive to be their best for every patient, every family, every day! Peggy Gordin, MS, RN, NEA-BC, FAAN Vice President, Patient Care Services ST. LOUIS CHILDREN’S HOSPITAL x5 2010 Nursing Awards St. Louis Children’s Hospital presents the Nancy A. Ross, RN, Nursing Awards each year. The awards are based on professional standards of nursing exempliﬁed by the Magnet® designation, a national award for nursing excellence: Rookie of the Year Yvonne Castaneda, RN, Cardiac ICU Excellence in Family-Centered Care Castaneda continually goes above and beyond with the patients and families that she serves. She is loved by families for her honest, caring and compassionate nursing care. She keeps families involved and informed. Kim Sauder, BSN, RN, CPN, 8 West General Medicine Excellence in Nursing Leadership Excellence in Professional Nursing Amanda Mattler, RN, CPN, Dialysis/Infusion/Pheresis Unit Mary Mintun, MSN, RN, Cardiac ICU A staunch supporter of family-centered rounds, Sauder serves on a task force that is evaluating the rounds process to ensure it meets the needs of patients and families, as well as the educational needs of residents. Mattler, the unit’s assistant nurse manager, was nominated by her entire team. She was praised for her ability to deal with challenging transitions in a positive way. Mintun, a charge nurse, has been instrumental in the planning, development and initiation of the Shared Leadership Council to improve patient care and provide a superior patient experience. Excellence in Mentoring Partner in Caring Ann Donze, MSN, RN, NNP, Newborn ICU Matthew Sinople, PCA, Cardiac ICU Donze was nominated for her ongoing mentorship and commitment to the Evidence-Based Practice (EBP) scholar students at SLCH. She was cited for her knowledge of the EBP process and ability to translate it to the practicing nurse at the bedside. Community Service Diane DuBois, MSN, MPH, RN, RN-BC, Answer Line Through several volunteer activities, DuBois supports the mission of improving the health of the people and communities the hospital serves. For example, each week she volunteers as an educator for grades kindergarten through eight at the Litzinger Road Ecology Center. Nurses say Sinople is kind and responsive to the needs of the families and staff of the Cardiac ICU, and often knows what is needed for the patient. Excellence in Nursing Research Barbara Gavillet, RN, RN-NIC, Newborn ICU Gavillet promotes excellence in nursing research at SLCH by being an EvidenceBased Practice (EBP) scholar and engaging in efforts to ﬁght bloodstream infections. TRANSFORMATIONAL LEADERSHIP 6 x 2010 ANNUAL REPOR T Nursing leadership identiﬁes and communicates the mission, vision and values within the organization and asks for the involvement of nursing to achieve goals. ST. LOUIS CHILDREN’S HOSPITAL x7 Amy McAlister, BSN, RN, CPN, CNN, shares her nursing experiences as a Dialysis Center nurse with Sue Harper, M+ (ASLP), medical technologist, Clinical Laboratories, as part of the Shadowing Program initiated by the hospital’s Shared Leadership Education Council. Shared Leadership contributes to the Superior Patient Experience What is Shared Leadership? Shared leadership is both a philosophy and a structure. The philosophy behind shared leadership is front-line staff are empowered to take the lead in making the decisions that affect patient care and parent and employee satisfaction. Front-line staff lead the councils that make the decisions while leadership mentors and supports the implementation of those decisions. Amy McAlister, BSN, RN, CPN, CNN, and her patient Shanna Basile. Patient Safety Council Development of the Good Catch Program and the role of the Safety Coach were key accomplishments achieved by the Patient Safety Council. The Good Catch Program rewards and recognizes staff who identiﬁed unsafe practices, thus preventing an error from reaching the patient. The Safety Coach is a staff member on each unit who champions safe practice initiatives and serves as a safety resource for staff. Professional Standards Council In an effort to promote discussion among Patient Care Services units and departments, the Professional Standards Council developed discussion toolkits for their representatives with the goal to engage staff in conversations around how professional presence affects safe care, effective care and exceptional service. The toolkit includes parent videos, survey results, staff pictures demonstrating dos and don’ts, commitment cards and tips on crucial conversations. Education Council A subcommittee of front-line staff from the Education Council has implemented an inter-professional Shadowing Program designed to gain knowledge and perspective of clinical processes throughout the hospital that contribute to the Superior Patient Experience. The program allows staff from many areas of the hospital the opportunity to shadow another department. They then bring their experiences back to their home department with the intent to strengthen relationships between disciplines/departments, and ultimately improve the inner-workings of St. Louis Children’s Hospital. 8 x 2010 ANNUAL REPOR T What SLCH nurses say about Shared Leadership St. Louis Children’s Hospital nursing staff participated in a survey this past year about Shared Leadership. Key results included: Becky Finke, BSN, RN, CPN, assists Claudia Claudio, RRT, with a BiPAP treatment. New respiratory care guidelines have been implemented through the Shared Leadership Clinical Practice Council. hospital and a customized unit-speciﬁc handout to communicate the most important information parents should know about the unit where their child is admitted. This guide eliminated the need to provide multiple single sources of information. Brandy Benetin, BSN, RN, shares helpful patient information about the 12th ﬂoor from the new Orientation Guide with Andrea Postawko, whose daughter was admitted to the Neurosciences unit. Performance Improvement Council The Performance Improvement Council identiﬁed an opportunity to standardize the educational content provided to parents on admission. A subgroup of this council created an Orientation Guide, which includes a Family and Patient Guide to Services, a Guest Information brochure with a map of the Clinical Practice Council Due to the vast amount of information and requests for practice changes that are presented to the Clinical Practice Council, a need was identiﬁed for a process to categorize clinical issues that would have the greatest impact on the patient experience. Staff members from the council prioritized these clinical issues and developed several task forces based upon the most pertinent clinical needs. As a result, several multidisciplinary respiratory care and vascular access guidelines have been approved and implemented. UÊ ÈäÊ«iÀViÌÊvÊÕÀÃ}ÊÃÌ>vvÊ believe Shared Leadership is important to patients and families UÊ {Ê«iÀViÌÊvÊÕÀÃiÃÊ believe Shared Leadership is important for the hospital. The survey also provided an opportunity for comments. Here’s what a few nurses wrote: “I think Shared Leadership has resulted in a more open environment and also has shifted responsibility to front-line staff. Keep up the process.” “It seems to be a very important way to improve the processes within the hospital by using the input and involvement of the employees.” “I am a rep, and I really enjoy meeting staff from different departments and learning about different perspectives.” ST. LOUIS CHILDREN’S HOSPITAL x9 The Shared Leadership Coordinating Council provides oversight for the coordination and integration of all councils. Members include: 1st row (top) from left: Amy Westfall, OTD, OTR/L Michelle Nadler, MSN, RN, CPNP-PC Anna Welbelhuth, PharmD 2nd row: Mara Bollini, MHA, BSN, RN Jill Malen Catherine Meyers Mary Mintum, MSN, RN Heidi Fields, MSN, RN, CPNP-PC 3rd row: Teresa Amrhein, BSN, RN, CPN Steffanie Rauscher, MHA, RN, CSSBB Peggy Conroy, BSN, RN {Ì ÀÜ\ Cindy Vishy, MSN, RN-BC Peggy Gordin, MSN, RN, NEA-BC, FAAN Sue Griffard, BSN, RN, RNC 5th row (bottom): Jim Burns, MT (ASCP), BS Barb Gavillet, RN, RNC-NIC Michelle LaGrone, MDiv Lisa Steurer, MSN, RN, CPNP-PC, CPN STRUCTURAL EMPOWERMENT 10 x 2010 ANNUAL REPOR T Nurses throughout the organization are involved in governance and decision-making structures and processes. ST. LOUIS CHILDREN’S HOSPITAL x11 S Simulation Center provides training ground for new transport nursing model The Transport Team at St. Louis Children’s Hospital dedicated the past two years in transitioning to a nurse-nurse-paramedic model for stafﬁng on most trips. The move was made due to scheduling challenges with resident physicians as well as benchmarking data from other pediatric transport teams. A comprehensive education plan to train nurses on the increased responsibilities included monthly blocks of time in the hospital’s Saigh Pediatric Simulation Center. Nurses wrote scenarios based on real trip situations and used the center for skillbuilding labs to practice such skills as intubation and placing lines. Sessions also were held to train physicians from each unit of the hospital to serve the role of medical control to respond to incoming patients and support the nurses over the phone during a transport. The new nursing model has given nurses increased pride in their team. “Transport Team nurses are highly trained and possess advanced skills,” says Kathy Donovan, BSN, RN, C-NPT, Transport Team manager. “The team is regarded as one place nurses can really use their skills and critical-thinking ability.” Nurses serve as single point of contact at new transfer center Pediatric nurses that staff Children’s Direct took on a critical role this past year as the centralized point of contact for patient transfers from other hospitals, direct admissions and dispatching the St. Louis Children’s Hospital’s Transport Team. Children’s Direct expanded to a full-service transfer center, and today these nurses continue to provide a seamless referral process for outlying hospitals, physicians and their patients. “Our experienced pediatric nurses at Children’s Direct—all with either critical care or emergency unit experience— are the clinical equivalent to air trafﬁc controllers, with their quick coordination of complex steps to get a patient here safely,” says Doug Carlson, MD, Children’s Direct medical director. “Our ﬁrst year has taught us a great deal about how we can continue to streamline the process. We actively seek input from our referring physicians so Jayson “Happy” Garcia enjoys a beautiful day on the hospital’s rooftop garden. we can make transferring patients to us even easier.” The Transfer Center is now available 24 hours a day, seven days a week. Customers are regularly surveyed regarding the nurse’s ability to quickly connect the referring and accepting physicians as well as their ability to provide pre-admission clinical information to physicians and nurses on accepting units. In 2010, Children’s Direct nurses managed 12,806 calls including: Transport Team nurses Michelle Sarli, BSN, RN, RNC, Angela Tumminia, BSN, RN, and Stefanie Senn, BSN, RN, participate in the treatment of an accident victim in the hospital’s Saigh Pediatric Simulation Center. UÊ Î]xxnÊÌÀ>ÃviÀÃ]Ê>Ê{Ê«iÀViÌÊVÀi>ÃiÊÛiÀÊÓää UÊ Ó]nÈÊÀiviÀÀ>ÊV>Ã]Ê>Ê£nÊ«iÀViÌÊVÀi>Ãi UÊ ÀiÊÌ>ÊÎ]xääÊ«iÊVÃÕÌ>ÌÊV>Ã]Ê>Ê>ÃÌÊ {ääÊ«iÀViÌÊVÀi>Ãi EXEMPLARY PROFESSIONAL PRACTICE 12 x 2010 ANNUAL REPOR T Nursing practice illustrates the mission, vision and values of the organization. Patient care is family-centered and nurses are accountable for clinical decision making and outcomes. Interdisciplinary collaboration is evident, as the nurse practices within a culture of safety in an environment that supports quality monitoring and improvement to achieve optimal patient outcomes. ST. LOUIS CHILDREN’S HOSPITAL x13 S New role for nurse practitioners Although the number of consecutive hours a resident can work dramatically decreased beginning July 2011, St. Louis Children’s Hospital will be prepared for these sweeping changes with a pilot program that incorporated nurse practitioners into the model of care on inpatients units. The trial care model replaced an intern with a rotating nurse practitioner. “This model supplements the new work-hour restrictions of interns and residents. It also adds someone to the care team who has managed the care of this patient population for a consistent period of time, which is often essential to the patients and families who come to us routinely for hospitalization,” says Susan Hibbits, MBA, OTR/L, FACHE, director, Neuroscience and General Medicine. “This new model of care will be a great blend, combining the educational focus of residents with the patient care expertise of nurse practitioners on 8 East,” says Cheryl Grave, MSN, RN, CPNP-PC. “As nurse practitioners, we have the opportunity to look at the big picture, not just a patient’s diagnosis. Because we treat complex patients, this is a challenging position, and I was thrilled to participate on the ground ﬂoor of this program.” Cheryl Grave, MSN, RN, CPNP-PC, checks in on her patient Zachary McClelland on 8 East. Mandt training helps staff face challenging situations More than 100 hospital employees, including nurses, PCT’s, Public Safety ofﬁcers and child life specialists, have participated in Mandt basic training to increase workplace safety through positive behavior and the development of healthy relationships. The philosophy of the Mandt System® “Putting People First” curriculum is based on the principle that all people have the right to be treated with dignity and respect. Approximately half of these staff members have completed advanced classes. Sara Weyhrich, MSN, RN, CPN, unitbased clinical educator, used her Mandt skills when faced with a 16-year-old patient with autism who often is a challenge for the 12th ﬂoor nurses. The patient became agitated and began banging his head with his hand, which caused a nosebleed. Sara used distraction, one of the techniques taught in class, to help the patient regain control of his behavior. Cindy Atkinson, RN, and Ken Robinson, Public Safety ofﬁcer, collaborated on Mandt training strategies on 7 West. “Mandt training reinforces staff to stay calm, talk through situations and communicate. Sometimes it demands ﬂexibility and open mindedness about a patient’s needs,” Weyhrich says. “A PCT on our ﬂoor used the training on another unit when a patient repeatedly requested a shower, although a shower wasn’t needed. The PCT granted the patient’s request and after a lengthy shower, the patient went directly to sleep. It was later discovered that a long, hot shower was part of this patient’s daily bedtime routine at home. 14 x 2010 ANNUAL REPOR T Healthy Kids Express celebrates 10 years, 100,000 Patients It’s been 10 years since the ﬁrst Healthy Kids Express hit the road. Mobile unit staff have seen more than 100,000 children and performed over 200,000 screenings including hearing and vision, anemia, lead, dental, asthma and scoliosis. Services also include height/weight measurements and immunizations. The service does not stop with screenings. Social workers and nurses follow up with families to resolve issues or potential problems identiﬁed by the exams. Healthy Kids Express provides services to 20,000 children per year, which is made possible through the generosity of donors to the St. Louis Children’s Hospital Foundation. This past year, the Healthy Kids Express dental program expanded its service. The van visits different sites four days per week to perform screening and cleaning, as well as restorative work including ﬁllings, extractions, stainless steel crowns and root canals. For many of these children it is their ﬁrst experience with dental care. Healthy Kids Express dental staff LaToya Wilson, DDS, right, and Jamelle Rucker, dental assistant, travel throughout the St. Louis area to provide dental care to children like Lauren Patrick. Because tooth decay is one of the most common childhood diseases in the United States, the Healthy Kids Express dental program visits schools and organizations to educate children, provide teeth cleaning and ﬂuoride treatments as well as exams and restorative care. On average, a child seen on the van has six or more cavities or dental problems. ST. LOUIS CHILDREN’S HOSPITAL x15 S Healthy Kids Express Milestones UÊ /ÀiiÊ{ävÌÊLiÊi>ÌÊÕÌÃ UÊ £äÊÞi>ÀÃÊvÊ«iÀ>Ì UÊ £ää]äääÊV`ÀiÊÃii UÊ Óää]äääÊÃVÀiiÃÊ«iÀvÀi` UÊ £ä]äääÊÕâ>ÌÃÊ«ÀÛ`i` UÊ Óä]äääÊV`ÀiÊÃiiÊÊÓä£ä Jamelle Rucker, dental assistant, provides an X-ray for Brad Patrick in order to give Dr. Wilson all the information needed for proper diagnosis. PROCESS IMPROVEMENT 16 x 2010 ANNUAL REPOR T St. Louis Children’s Hospital receives more than 50,000 visits each year to its Emergency Unit. In order to continue to provide a superior patient experience, several process improvement efforts have focused on the continuum of emergency care to enhance comprehensive service to patients and families. ST. LOUIS CHILDREN’S HOSPITAL x17 S Resource nurse Patients and families that come to the Emergency Unit (EU) for urgent care now have access to a Resource Nurse, a nurse completely dedicated to providing a seamless transition to inpatient care. Initially trialed on the hospital’s inpatient units, today this role is based out of the EU to help with admissions and ﬂuctuations in census. Float pool nurses staff the position because of their unique skill set and experience of working on all inpatient units, ICUs and the EU, and with the inpatient documentation systems. The Resource Nurse starts the admission process by reviewing medical information and meeting the patient and family immediately after arrival. Additional information is gathered while initiating the admission history proﬁle, which often can be completed before the patient even leaves the EU. As time permits, the Resource Nurse will transport patients from the EU to inpatient units, orient them to their room and settle them in for their stay. The scope of the role continues to develop with ongoing feedback from all staff involved. Resource nurses report that it’s rewarding to help staff and advance care while spending more time with patients and families. Resource Nurses like Megan Thomas, BSN, RN, have given patients and families a better admission process and provided much-needed assistance with EU workﬂow. EU throughput improves patient experience Two years ago, opportunities were identiﬁed to improve the patient experience in the EU, a critical access point to St. Louis Children’s Hospital. Project teams led a comprehensive effort that resulted in a decrease in the number of patients that leave without being seen (LWBS) to less than 3 percent and a decrease in a patient’s average length of stay (ALOS) for discharge to home patients to less than 165 minutes. The project continued into 2010 to ﬁnd new ways to improve care while sustaining the improvements made in 2009. Team members continued to improve throughput by piloting and implementing enhanced workﬂow methods and adjustments to surge plans The EU Throughput project team added a hospitality approach when patients must wait. Staff like Dan Bruns, BSN, RN, received appropriate scripting for patients and their families. by analyzing EU data for additional triggers. Projects were added, including piloting a pediatric nurse practitioner at triage and development of training tools, such as a hospitality approach involving scripting for waiting patients and creation of an EU decisionmaking game. Similar to Monopoly, the game was based on triggers to test the department’s surge plan and its effectiveness in patient throughput. Patient experience scores remained above target throughout the year. NEW KNOWLEDGE 18 x 2010 ANNUAL REPOR T Innovations and improvements, evidence-based practices and research are integrated into clinical and operational processes. Innovation is encouraged to discover new ways to achieve high quality and effective and efﬁcient care. ST. LOUIS CHILDREN’S HOSPITAL x19 S Evidence-Based Practice Evidence-Based Practice (EBP) is a problem-solving approach to clinical practice that integrates the use of best evidence in combination with a clinician’s expertise and patient preferences to make decisions about the care provided. Since 2007, St. Louis Children’s Hospital has offered an annual EBP Scholar’s Program that instructs the bedside nurse in this process. Several projects have been developed since the program’s inception to improve patient outcomes. In some cases, enough evidence is found to change practice immediately. In other cases, more research is needed before a practice change can be implemented. Sabbatical changes practice, decreases BSI Like so many nurses, Barb Gavillet, RN, RNC-NIC, is passionate about the babies she cares for in the Newborn ICU. When she joined the hospital’s Evidence-Based Scholars Program, she already had a question in mind: What is the best practice for changing IV lines in the Newborn ICU? Gavillet found little information during a literature search and a benchmark study with half a dozen hospitals. Unable to locate a standard practice, Gavillet’s mission to improve the health of her patients led the Newborn ICU nurse to launch a sabbatical. “When I was approached about the sabbatical, I wasn’t sure where to begin, but I received so much support from everyone,” she says. “It was something that I really believed in. I thought changing our IV lines every 24 hours would reduce our bloodstream infections (BSI) in the Newborn ICU. Every time a line is opened, the risk of infection increases.” A few months following this practice change, the Newborn ICU experienced a drop in BSIs and went 80 days without an infection. And, Gavillet’s work continues. Plans call for trials of a new Broviac dressing and a chlorhexidine impregnated, timereleased foam patch to further decrease BSIs. BSI Sabbatical Steps Barb Gavillet, RN, RNC-NIC, and patient Ian O’Connor. Her efforts have contributed to decreases in Newborn ICU bloodstream infections. UÊ `ÕVÌi`Ê>ÊÃ«Ì>ÊÃÌiÊÛÃÌÊÌÊ learn about new practices using chlorhexidine and biopatches. Patient education tools are critical teaching resources for Tina LaPlant, RN, assistant nurse manager, Same-day Surgery, with patient Johnny Reynolds. UÊ i}>ÊÌÞÊ-ÊÌ>ÃÊvÀViÊ comprised of front-line nurses. UÊ ÃÌÌÕÌi`ÊViÌÀ>ÊiÊÕÀÃiÊÌÊ manage lines and dressings. UÊ iÛi«i`Ê}ÀÕ«ÊvÊvÀÌiÊ nurses as Broviac super users, specially trained on application of dressings. UÊ ÃÌ>LÃi`Ê>VÌÊ«>ÊÜÌÊ Pharmacy to reconstruct their work load and ﬂow to accommodate change. UÊ *ÀiÃiÌi`Ê«À>VÌViÊV>}iÊ recommendation to Unit-Based Joint Practice Team and received full physician approval. UÊ ÌÀ`ÕVi`ÊÓ{ÕÀÊ6ÊiÊV>}iÃ° 20 x 2010 ANNUAL REPOR T ST. LOUIS CHILDREN’S HOSPITAL x21 S Evidence-based practice project focuses on exercise “The EBP program gets your feet wet and then once you get a project rolling, it opens up a whole new world to you,” says Jeff Filipiak, BSN, RN, CPN, assistant nurse manager, 7 East. He has devoted this past year to preparing for what could result in a new approach to inpatient exercise for children with cystic ﬁbrosis (CF). Filipiak’s EBP project will test the concept of exercise using video gaming on patients with CF. Traditionally on isolation, these patients receive daily physical therapy by using either a treadmill or lower body ergometer once a day in their rooms. Filipiak and his EBP research team hope that study participants ﬁnd enjoyment using Wii gaming equipment that is both purposeful and visually stimulating. “Ultimately, exercise is a big part of staying healthy for a patient with CF, and we are optimistic that the Wii may change their exercise habit,” Filipiak says. “Parents of children with CF are always looking for ways to engage their child in activity, and exercising on the Wii while in the hospital can provide for a new and fun way to get that much-needed exercise.” Brandi Richard, BSN, RN, and Emily Vannoy, BSN, RN, are among the staff on the 10th ﬂoor nursing unit that dedicated their efforts to bringing nursing quality metrics above 90 percent compliance. Bulletin boards located on the inpatient surgical ﬂoor display each of the unit’s quality measures and progression toward success. 10th Floor achieves quality goals In an effort to improve the quality of nursing care on their unit, the 10th ﬂoor inpatient surgical unit devised strategies to achieve a 90 percent or higher compliance rate on 15 different nursing quality metrics. With support from their Unit-Based Joint Practice Team, nurses identiﬁed the following quality metrics as priorities: UÊ hand hygiene Using the Wii, Landon Fryepoore tries running in place in his room with Clayton Copley, LPTA, and Nikki Danis, BSN, RN. UÊ fall risk UÊ admission height and weight UÊ admission pain score. Improvement strategies included staff meeting discussions and badge reminder cards on compliance issues. Nurses went a step further to request detailed audits—in instances such as when they failed to document following a pain reassessment—so they could understand where to focus their personal opportunities for improvement. BUILDING SYSTEMS OF SAFETY 22 x 2010 ANNUAL REPOR T St. Louis Children’s Hospital is creating structures and approaches to continually improve patient safety. From pursuing technologically advanced teaching methodologies to creating a culture where front-line nursing staff can become leaders focused on patient safety initiatives, nurses strive to achieve optimal patient outcomes. ST. LOUIS CHILDREN’S HOSPITAL x23 S Nurses change heparin practices in Cardiac Catheterization Lab Several nurses who participated in a performance improvement training class used their new skills to study recent medication errors involving the use of the “high alert” drug heparin in the Cardiac Catheterization Lab (CCL). Nurses shadowed CCL staff to observe current procedures and prepared a process ﬂow chart, which indicated gaps and inconsistencies during medication preparation. Their evaluation found that two syringes were on the sterile ﬁeld — heparin, administered for de-coagulation, and lidocaine, used to numb the skin. “By understanding the process, we were able to standardize it, develop comprehensive guidelines as well as implement the preparation of only one form of heparin for the sole purpose of de-coagulation of patients. This syringe is not put on the sterile ﬁeld, but is now drawn up and administered at the point in which it is needed,” says Mary Hoffner, MBA, BSN, RN, CPN, patient safety specialist. “Now just one syringe is placed on the sterile ﬁeld at any time, which eliminates the possibility of someone picking up the wrong syringe.” Now in the control phase of the project, Lori Balzer, BSN, RN, charge nurse, Cardiac Catheterization Lab, Mary Hoffner, MBA, BSN, RN, CPN, patient safety specialist and Mary Mintun, MSN, RN, charge nurse, Cardiac ICU, seek additional project outcomes in the coming months. Good Catch program promotes patient safety As part of Shared Leadership and the Patient Safety Council, the Good Catch program was introduced to recognize and reward staff members who identify a risky situation and intervene in order to lessen or prevent harm to patients, families and staff. The overall intention of the Good Catch program is to promote safe and effective care. Award example: A medication had been ordered and reached the unit for one of Jennifer Jacobi’s patients. She noted that the medicine was different from the one infusing and alerted the physician before giving the new medication to the patient. Jennifer Jacobi, RN, prevented an incorrect medication from being administered to her patient on the 12th ﬂoor. She received a Best Catch award for her efforts. Award example: Pediatric ICU nurse Jessica Peters, RN, prevented an incorrect medication from being administered to her patient. The medication was inadvertently ordered for her patient, but Jessica recognized that the indications for that medication did not ﬁt the patient’s diagnosis or post-operative care plan. She further inquired with the parents whether their child was prescribed that medication at home, and they said it was not. Jessica Peters, RN, was recognized with a Good Catch award because she prevented an incorrect medicine from being given to her patient in the Pediatric ICU. 24 x 2010 ANNUAL REPOR T Carol Strobl, RN, and Dr. Lisa Madden can now review a patient’s treatment roadmap online, thanks to the introduction of computerized provider order entry on 9 West. Computerized provider order entry offers safer chemotherapy practices Days before chemotherapy is prepared for a child, dozens of staff are involved and many checks and balances have to be completed. When chemotherapy protocols were planned to become part of KiDDOS (Komputerized Inter-Disciplinary Documentation and Ordering for Safety), a yearlong collaborative planning process was initiated. Input from oncology physicians, nurses and pharmacists was crucial to build the safest system possible for administering chemotherapy to children with cancer. Since the process involved in ordering chemotherapy is unique, the task force overcame many challenges. The new system now provides an electronic dosage calculation that reduces or eliminates human error, as well as any confusion caused by unclear handwriting. In addition to the actual chemotherapy agents, the KiDDOS orders contain all of the monitoring parameters necessary with the agents to add another layer of safety. “The order sets standardize the way chemotherapy is written so there is consistency in prescribing practices by the providers, which improves the process for each step down the line, including dispensing and administration of the agents,” says Deborah Robinson, MSNR, RN, APRN, BC, PNP, CPON. “In addition, standardized order sets for the most common diseases are built into the KiDDOS system, providing additional safety in the process and increasing the time providers can spend with patients.” Aaron Hines, BSN, RN, with 7 West patient Brooklynn Shipp as she prepares to go home to Springﬁeld, Mo. ST. LOUIS CHILDREN’S HOSPITAL x25 S 26 x 2010 ANNUAL REPOR T 2010 by the numbers Education Simulation 26% Associate’s degree or diploma 59% Bachelor’s degree 16% Master’s degree 2,190 6 1% Doctorate 178 Nurses currently in school 74 450 89 Pursuing master’s degree 13 Pursuing doctorate 20 Nursing school afﬁliations 71 Oral presentations Participants 37 Poster presentations Research projects 15 Publications 16 Current research projects Professional Development 322 88 Nursing Grand Rounds presented 336 Nursing Grand Rounds participants 104 Continuing education programs 4,674 Training events Pursuing bachelor’s degree 365 8 Advancing Nursing Practice 36 Nurses who are certiﬁed within a specialty Nurses who worked in summer camps for children with special needs or chronic illnesses 810 Community education events Professional Nurse Development Program participants 24,706 Total current evidence-based practice scholars Served by the Family Resource Center health information library 72,736 After Hours calls 28,091 Answer Line calls 32,950 Screened by Healthy Kids Express Screened on Healthy Kids Express Mobile Health Vans Oral and Poster Presentations 400 152 Nurses who are members of professional organizations Continuing education program participants Certification Community Outreach 200 35,000 32,950 365 166 320 163 160 29,000 264 121 240 120 224 108 105 206 23,000 180 17,746 160 80 17,000 118 13,433 80 0 40 2005 2006 2007 2008 2009 2010 0 41 2005 11,000 9,433 9,134 2006 2007 2008 2009 2010 5,000 2005 2006 10,789 2007 2008 2009 2010 More than 15,000 patients were admitted to St. Louis Children’s Hospital in 2010. Ashanti McDalton was a patient on the hospital’s 7th ﬂoor. ST. LOUIS CHILDREN’S HOSPITAL x27 S ONE CHILDREN’S PLACE | ST. LOUIS, MISSOURI | 63110 | 314.454.6000 | STLOUISCHILDRENS.ORG SLC9956_8.11