Nursing - SSM Health Nurses/… · Nursing Professional Practice Model ... • Inpatient cardiology/telemetry ... huddles, debriefs, SBAR and CUS words have been

In Our Hands

2015 Nursing Annual Report

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CNO/VP Nursing Welcome Letter ............................................................................................................................... .............................................................. a

SSM Health Mission, Vision and Values ............................................................................................................................... .................................................b

1. Transformational Leadership ............................................................................................................................... ..............................................................1

Care for Caregivers ............................................................................................................................... .................................................................................................1

TeamSTEPPS ............................................................................................................................... ................................................................................................................. 1

Nursing Mentorship ............................................................................................................................... .............................................................................................. 2

A Nurse-Driven Practice Change ............................................................................................................................... .......................................................... 2

2. Structural Empowerment ............................................................................................................................... ........................................................................ 3

Inter-Professional Decision Making — Driving Change ............................................................................................................................... ..3

KIDS KARE............................................................................................................................... ..................................................................................................................... 4

Nursing Workforce Overview ............................................................................................................................... .................................................................... 5

Certifications ............................................................................................................................... ............................................................................................................... 5

Degrees Earned ............................................................................................................................... ........................................................................................................ 5

Professional Organizations............................................................................................................................... ...........................................................................6

Futures Program ............................................................................................................................... ...................................................................................................... 6

Publications ............................................................................................................................... ................................................................................................................... 7

Honors and Awards ............................................................................................................................... .............................................................................................. 7

NLNL 2020 Scholarships ............................................................................................................................... ....................................................................... 7

BSN Scholarship ............................................................................................................................... .............................................................................................. 7

Certification ............................................................................................................................... .......................................................................................................... 7

Daisy Award Winners ............................................................................................................................... ................................................................................ 7

Great Catch Winners............................................................................................................................... ........................................................................................... 8

Nurses’ Week Award Recipients ............................................................................................................................... ............................................................9

Lifetime Achievement Award ............................................................................................................................... ...........................................................9

Table of Contents


Table of Contents (continued)

3. Exemplary Professional Practice ............................................................................................................................... ...............................................10

NDNQI Nursing Practice Environment Satisfaction Survey ..................................................................................................................10

Weigh-In Wednesdays ............................................................................................................................... ..................................................................................10

Nursing Professional Practice Model ............................................................................................................................... ...............................................11

Communication Beyond a White Board ............................................................................................................................... .................................... 12

Clinical Data Outcomes ............................................................................................................................... ................................................................................ 12

Falls with Injury Per 1,000 Patient Days ............................................................................................................................... ............................. 12

Hospital Acquired Pressure Ulcers Stage 2 and Above ................................................................................................................... 12

CLABSI ............................................................................................................................... ................................................................................................................... 13

CAUTI ............................................................................................................................... ...................................................................................................................... 13

Patient Satisfaction Scores ............................................................................................................................... ....................................................................... 13

4. New Knowledge, Innovation and Improvements ............................................................................................................................... 14

Peer Review Pilot ............................................................................................................................... .................................................................................................. 14

ED Blood Culture Contamination Reduction ............................................................................................................................... .......................... 15

Changing the Process ............................................................................................................................... ............................................................................ 16


a

CNO/VP Nursing Welcome Letter

Dear Nurses,

It has been my privilege to serve as the Vice President of Nursing (Chief Nursing Officer) at SSM Health St. Clare Hospital – Fenton since October 2013. More than a beautiful building and high-tech equipment, SSM Health St. Clare is defined by the compassion, dedication and skill of our nursing staff. Our nurses are among the best, and their practice reflects the highest standards of nursing excellence. I am inspired by the dedication, passion and commitment I witness during my rounding, Daisy Award presentations, Great Catch recognitions, patient letters of satisfaction and the highest quality outcomes. I am committed to maintaining a work environment where nurses can thrive and aspirations are achieved.

We have a proud history of shared governance and nursing practice councils. This structure allows our nurses to have a strong voice in their own practice at SSM Health St. Clare. Our nurses are professional, accountable, collaborators, advocators and leaders. Development of our nursing staff and leaders is the cornerstone of our current and future success. SSM Health St. Clare nurses are responsible for patient quality and safety outcomes, and for reviewing their NDNQI unit data on a regular basis with subsequent action plans to achieve top decile performance.

What makes SSM Health St. Clare nurses unique? They are passionate about their professional practice and unwavering in their commitment to making a difference every day in the lives of the patients and families they serve. The Mission of SSM Health is alive inside the caring hands of each of our nurses. The Nursing Annual Report is designed to highlight a few of the many accomplishments of the previous year.

We are blessed to practice in a community that appreciates our efforts to support a healthier tomorrow by collaborating across the continuum. Our 143-year SSM Health heritage of healing inspires us to continue courageously, and I am confident that the future of SSM Health is safe in your hands. I thank you for choosing to practice at SSM Health St. Clare, and I will continue to serve you on our journey to excellence.

Wayne Laramie | Vice President Nursing SSM Health St. Clare Hospital


SSM Health Mission, Vision and Values

Mission

Through our exceptional health care services, we reveal the healing presence of God.

Vision

Through our participation in the healing ministry of Jesus Christ, communities, especially those that are economically, physically and socially marginalized, will experience improved health in mind, body, spirit and environment within the financial limits of the system.

Values

Respect We respect life at all stages and promote the dignity and well-being of every person.

Compassion We reveal the healing presence of God through compassionate care focused on the fullness of the person.

Excellence We provide exceptional care and service through employees and physicians dedicated to our Mission.

Community We cultivate relationships that inspire service and promote justice in our organization and throughout our communities, with special concern for the poor and marginalized.

Stewardship We use our financial, human and natural resources responsibly and care for the environment.

b

SSM Health Mission, Vision and Values


1. Transformational Leadership

Care for CaregiversCare for Caregivers is a program designed, originally at the University of Missouri and adapted at various hospitals within SSM Health, to facilitate emotional care of “Second Victims.” Through both SSM Health St. Clare NDNQI and safety surveys, results indicated the employees needed more support during stressful situations. A steering team was formed and current practices at both SSM Health DePaul Hospital and SSM Health Cardinal Glennon Children’s Hospital were reviewed. The nursing-led team met and designed a program to best meet the needs of SSM Health St. Clare.

A timeline was established and education developed. Nursing led the training of the entire hospital. Leadership and designated employees were trained as Tier 2 supporters, and all other team members from every discipline will complete training as Tier 1 supporters in early 2016.

Quarterly updates, review of program and results will begin in the summer for Tier 2 supporters.

TeamSTEPPSEven highly educated and skilled teams can be prone to human error. Acknowledging this, the nursing leadership team at SSM Health St. Clare has adapted AHRQ’s TeamSTEPPS to our culture of safety. All nurses from high-risk areas such as the cardiac cath lab, emergency department, Family Birthplace, intensive care unit, interventional radiology and operating room have been trained, as well as nurses from the following areas:

• Endoscopy

• Pre-op/PACU

• Inpatient cardiology/telemetry

• Inpatient neurology

In 2016 we will see the completion of in-patient nursing training, as well as the administrative supervisors. TeamSTEPPS tools such as briefs, huddles, debriefs, SBAR and CUS words have been integrated into our everyday practice, with leaders regularly recognizing and rewarding employees for

“great catches” and “stopping the line."

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Transformational Leadership

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Nursing MentorshipSSM Health St. Clare is dedicated to the professional development of its nursing team.

Family Birthplace nurse Jennifer Geyer, RN, BSN, was unsure of the need to continue her education to obtain her MSN. Jennifer had recently married, started a family and doubted she could commit the time required to obtain the degree. Thanks to Jennifer's nurse leaders' mentoring and encouragement, she is not only on track to complete her MSN by the end of 2016, she is also teaching others. Jennifer is now a clinical instructor at a Maryville University – St. Louis and encourages others to return to school. She frequently shares that she has become more knowledgeable and prudent from this experience.

Family Birthplace nurse Emily Berghult, RN, BSN, also returned to school to obtain her MSN, with a focus on education. As part of an assignment, Emily approached her nurse leaders about the feasibility of developing a breastfeeding support group at the hospital. Such a program would meet her course requirement, as well as benefit the hospital’s performance in The Joint Commission’s Perinatal Care Core Measure PC05 and provide a community benefit. The weekly support group is led by an IBCLC and has consistently met for more than a year.

Casey Lairmore, Administrative Supervisor, was determined to complete her MBA and obtain a leadership role within nursing. Through structured updates with the administrative director of nursing operations, Casey was able to establish goals and refine her skills as a leader. These structured, quarterly conversations allowed Casey to enhance her talents as the leader of hospital-wide projects. This experience prepared and allowed her to network with nursing leaders. In early fall 2015, Casey accepted a role as a team leader at our sister hospital SSM Health St. Joseph Hospital – St. Charles.

A Nurse-Driven Practice ChangeSally Merkel, RN, IV Therapy, was determined to change the practice of IV-guided placement of PICCs. Sally reviewed the research on the most up-to-date technology for the confirmation of PICC placement. In her review, Sally discovered EKG-guided PICC placement confirmation. The Health Care Advisory Board provided a case study where a hospital was able to decrease cost by $51,000 annually and decrease the confirmation wait time by 30 minutes. In addition, Sally spoke with nurses who have published articles regarding this topic to understand the parameters they established and the process they undertook to change their practice. Sally compared EKG positive confirmation with 40 patients

Transformational Leadership


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to X-ray confirmation. She positively identified 39 of the patients through EKG confirmation. The one patient that fell out met exclusion criteria based on the evidence research Sally conducted. Sally met with the Chief Medical Officer, and her practice request was unanimously approved by the Medical Executive Committee of the hospital.

2. Structural Empowerment

Inter-Professional Decision Making — Driving ChangeFor some time, patients with established trachs were not taken on the medical/surgical floors. A decision was made to start allowing these patients on the floors, and education was completed “just in time” when a patient was coming to the floor. No patients were sent for some time, and when several were sent all at once, Respiratory Therapy (RT) tried its best to complete

“just-in-time” training with nursing.

Nursing voiced concern. They felt the education was insufficient, and they didn’t have the supplies needed to care for the patients.

A team was formed with both medical and surgical staff nurses and respiratory therapists to address this concern. The decision was made that a cart with all needed supplies would be created by RT and delivered to the floor when a patient with an established trach was admitted.

With time, an order for “established trach” was put into Epic, and the nurse could order the cart with the needed supplies. Together, nurses and RT created a solution to an identified patient safety issue.

Structural Empowerment


KIDS KAREThe KIDS KARE TEAM is a multidisciplinary group of employees whose primary focus is to provide evidence-based practices in pediatric care at SSM Health St. Clare and its surrounding community. The program was initiated and led by a staff nurse, Linzi Bereitschaft, RN, BSN, in the emergency department (ED) in collaboration with the Medical Director of Glennon Care. The team’s goal is to educate team members on the latest trends in pediatric care through regularly scheduled meetings, seminars, practical workshops and other pediatric specialties across SSM Health. Membership consists of ED, nursery and radiology nurses, pediatric and neonatal physicians, ED techs, respiratory therapists, pharmacists and paramedics.

The KIDS KARE TEAM is present in the community. They provided and fit more than 200 helmets at the 2015 Greentree Festival in Kirkwood. This past fall, the KIDS KARE TEAM was present at all Rockwood High School football games, ensuring consistent and state-of-the-art care for injured players. The school was so thankful and impressed with the care provided, they presented the KIDS KARE TEAM with a helmet of thanks.

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Certifications

Veronica Dalton CCRN Nancy Baldwin CRNFA Donna Robinson CCRN

Maureen Deutman CWOCN Debbie Couchman CRNFA Lauren Vokaty CCRN

Laurie Klipfel CDE Nancy Duncan CRNFA Barb Rebstock CRNFA

Lynn Badalamenti CCRN Colleen Eisenbarger CRNFA Sandy Rogers CRNFA

Kendra Meives CCRN Rebecca Feltmann CRNFA Dabney Vaccaro IBCLC

LuAnn Gregson CCRN Jim Guthrie CRNFA Amy Williams CMSRN

Angie Stahlman CCRN Diane Helwig CRNFA Padma Akumalla CRNFA

Shea Ren CCRN Raelynn Imm CRNFA Veronica Paur CIC

Michele Ziegler CCRN Tracy Kaddouri CRNFA Maureen Bell SCRN

Pat McCracken CCRN Sherry Oliver CRNFA Kimberly Beatty CCM

Pat McCracken ACNS-BS Kim Pastrana CRNFA

Degrees EarnedRN to BSN | Nine MSN | Seven

SSM Health St. Clare Hospital Nursing Workforce Overview

Number of Licensed Beds 184 (175 in use)

Total Employees 1,038

Number of Active Physicians 231

Number of Volunteers 242

2015 Admissions 10,526

2015 Births 1,152

2015 Emergency Visits 42,536

2015 Outpatient Visits 71,842

2015 Inpatient Surgeries 2,510

2015 Outpatient Surgeries 3,594

49%Nurses

51%Other

Total Workforce | Nurses

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Professional Organizations

Emergency Nurses Association AACN MONL AONE

Futures ProgramThe future of nursing relies on the nurses who are entering the field from nursing schools. It is our strong commitment to the transition of these nurses into the practice environment that made the Futures program successful at SSM Health St. Clare. In 2015, the majority of Futures nurses were hired from external candidates. Forty percent of the candidates were hired from internal positions — monitor techs, care partners and ancillary departments. Of the 28 Futures nurses, we had a retention rate of 93 percent.

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Futures Graduation 2015


40%of candidates

were hired from internal positions


Publications

Honors and Awards

NLNL 2020 Scholarships

SSM Health St. Clare awarded $16,500 to support our nurses in completing BSN degrees and $1,105 to support our nurses in obtaining certification.

BSN Scholarship Certification

Aimee Monrotus CCM | Kimberly Beatty

Linzi Bereitschaft CIC | Veronica Paur

Stefanie Harvey SCRN | Maureen Bell

Emilie Meier CCRN | Shea Ren

Daisy Award Winners

January Kelly Remaklus 2 North

February Allison Hacay 5 North

March Nicklette Clark 5 Infusion

April Kendra Meives ICU

May Mary Gardner ED

June Shea Ren ICU

July Jeannie Hall 4 South

August Tiffany Blandford 5 South

September Natalie Crandall 4 South

October Andre Tolliver ED

November Melanie Schwob FBP

Articles

Stuesse, E. (2014). Clinical Nurse Leaders and Clinical Nurse Specialists: Harmonious Partners. American Nurse Today. 9 (4).

Retrieved from: http://www.americannursetoday.com/clinical-nurse-leaders-and-clinical-nurse- specialists-harmonious-partners/

Stuesse, E. (2015). I Found Happiness in the Classroom! Reflections on Nursing Leadership

Retrieved from: http://www.reflectionsonnursingleadership.org/Pages/Vol41_3_Stuesse.aspx

Daisy Award Winners

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Allison Hacay Kelly Remaklus


NLNL 2020 Scholarship Winners

Stefanie Harvey Linzi Bereitschaft

Aimee MonrotusEmilie Meier


Kathleen Konys, RN 4th Floor

Melisa Ferhatovic, RN 5th Floor

Emilie Meier, RN 5th Floor

Kim Adams, RN FBP

Great Catch WinnersDeanne Mead, RN FBP

Morgan Jensen, RN OR

Lori White, RN Ambulatory Surgery Sandy Null, RN OR

Becca Spencer, RN ED Rebecca Jestes, RN Ambulatory Surgery

Emily Thoele, RN Cath Lab Yvonne Smith, RN FBP

Melissa Allen, RN Cath Lab Sarah Heideman, RN FBP

Ashley Burgess, RN Cath Lab Amber McCallister, RN 5 South

Natalie Sevem, RN 5 South Taraneh Divanbeigi, RN 5 South

Jen Rowett, RN 5 North Shaun Karleskint, RN IVR

Renee Berry, RN 3 North Flex Jessica Christian, RN ED

Molly LaBrier, RN ED Becky Kuykendall, RN FBP

Dena Powell, RN ICU Angel Cantrell, RN 5 North

Jen Geyer, RN FBP Tony Petrillo, RN 5 North

Allison Hacay, RN 5 North (x2) Laura Busk, RN FBP

Kelly Reilly, RNFA OR Maggie Burns, RN Administrative Supervisor (x2)

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Nurses’ Week Award Recipients

Outstanding Achievement | Kathy Sliefert, RN

Rookie of the Year | Andre Tolliver, RN

Mentor/Clinical Coach of the Year | Katie Klumb, RN

Nursing Practice and Professionalism | Traci Garner, RN

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| Kathy Sliefert

As the first recipient of SSM Health

St. Clare Hospital's Lifetime

Achievement in nursing award,

Kathy Sliefert represents a strong

dedication to the profession of nursing.

She began her career at St. Joseph

Hospital in Kirkwood in 1981 as an RN

instructor. During her time with us, she

served in many roles, from director

of skilled nursing to infection control/

workers comp, clinical director and most

recently nursing administrative supervisor

until she retired. She is commonly known

as "Mama Slief" in the halls of SSM Health

St. Clare. Her knowledge, calm presence

and desire to create a feeling of family

amongst the employees is unsurpassed.

Lifetime Achievement Award



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Exemplary Professional Practice

3. Exemplary Professional Practice

NDNQI Nursing Practice Environment Satisfaction SurveyIn late summer of 2015, SSM Health St. Clare nurses responded to questions about their satisfaction with the practice environment. Overall, the satisfaction scores of the hospital and each individual unit increased over the 2012 survey results. Additionally, 91% of the units outperformed the mean in the majority of the domains. The identified domain of opportunity — adequate staffing — resulted in on-campus recruitment fairs, plans for the largest Futures class accepted and several retention strategies for prioritized units.

Weigh-In WednesdaysImplementing a free, open-house style, weekly mother-to-mother support group at SSM Health St. Clare allowed breastfeeding women to openly ask questions and address concerns with other mothers who may be experiencing similar post-partum experiences.

Mothers are encouraged to come to discuss problems and achievements with other mothers. A lactation consultant or mother/baby nurse from the Family Birthplace is available at the support group to answer any questions. The nurse offers each mother the opportunity to weigh her child before and after a feed, to reassure weight gain and adequate feedings.

NDNQI Mean

SSM Health St. Clare Hospital

RN to RNInteraction

Foundation ofQuality Care

ManagerLeadership

AdequateSta�ng

SSM Health St. Clare Hospital – Fenton2015 NDNQI RN Survey Results

0 1 2 3 4 5 6 7 8

As a hospital, SSM Health St. Clare had 62% of all its eligible nurses participate in the survey. Out of the 18 nursing units participating, 13 had a participation rate of 50% or greater; 5 North Medical/Surgical Unit and 4 North/South Cardiac/Neurology had 100% and 95% participation rates, respectively. These high participation rates demonstrate an incredible response and engagement of our nurses in improving their practice environment.


Strategic Direction for NursingProfessional Nursing Practice at SSM Health creates an innovative environment for

the achievement of exceptional outcomes while advancing and contributing to the profession. We partner with patients, families, providers and each other,

using practices that are restorative, supportive and promotive in nature. SSM Health is the preferred partner for care across the health continuum.

Our Miss

ion: Through our exceptional health care services, we reveal the healing presence of God.

Shar

ed Leadership • Relationship-Based Care

Nursing Professional Practice Model

EXCEPTIONAL Experience • People • Value

I am aleader

I am anadvocate

I amaccountable

I am apartner

I am aprofessional

I am an SSM Health Nurse

Patient and

Family

Sacred Trust

Our V

alues

: Compassio

n • Respect • Excellence • Stewardship • Community

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Report cards for the mothers are given at the first visit. The card is for the mother to keep track of dates, feeds and weights. The back of the card has the graph of the normal growth curve for infants; mothers can plot on the graph to keep track of baby’s growth, if desired. Mothers are encouraged to bring the infant’s report card to each visit to watch their baby’s trends.

The outcomes from these support groups are to give new mothers the knowledge, patience and confidence it takes to breastfeed their babies for the recommended six months or longer, making healthier moms and healthier babies in our community.


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Communication Beyond a White BoardWhen SSM Health St. Clare Hospital was built in 2009, designers chose non-traditional, clear glass white boards, and each floor decided how best to utilize them. Staff immediately

noticed that there was no room number identification. The room

and phone number were then incorporated. The nurse’s phone

number was also generally added.

As time passed, communication with nurses was seen to be an on-going

house-wide opportunity for its use. Research was begun on development of a

more comprehensive white board.

A literature review was completed to explore current thinking on the best use of a white board and

to determine best practices. Evidence showed that white boards need to be patient-centered, rather than care team-

centered to provide the patient and family with the information needed to be better informed about care.

Using elements found in the literature review, a first draft white board was developed on paper, printed to size and made the rounds of all inpatient units on

which it would be used. Ideas were sought from nurses, physicians, patients and families. The board design was then updated incorporating the ideas.

The updated boards were hung in patient rooms at eye level, easily seen from the bed, with markers readily available for staff use. Education “talking points” were developed and distributed to employees during the implementation period. More education is being completed with employees weekly, with each education session diving further into the need for the board, how to complete it.

Clinical Data OutcomesBenchmarking against the NDNQI hospital compare groups, SSM Health St. Clare has clinically superior outcomes in the four key clinical areas.

Falls with Injury Per 1,000 Patient Days — SSM Health St. Clare outperformed the mean for the last eight quarters in regards to falls with injury.

Hospital Acquired Pressure Ulcers Stage 2 and Above — SSM Health St. Clare outperformed the mean for the last eight quarters for hospital acquired pressure ulcers.



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CLABSI — For central line associated blood stream infections, SSM Health St. Clare outperformed the mean six out of the last eight quarters. The slight change in the second and third quarters of 2015 led to extensive practice changes within the intensive care unit. Bedside audits were reinstituted so that peer-to-peer feedback can be given in the moment. ICU patients began being bathed with a chlorhexidine preparation on a daily basis.

CAUTI — The hospital outperformed the mean in seven out of the last eight quarters for catheter associated urinary tract infections.

Patient Satisfaction Scores Teal at or >90% Orange at or <49%

Received Date (Compare Group - All)

Q1 14

Q2v 14

Q3 14

Q4 14

Q1 15

Q2 15

Q3 15

Q4 15

HCAHPS Rate Hosp. (9-10) 91 89 94 91 85 89 89 83

Recommend Hospital 90 89 94 92 86 89 88 89

Communication with Nurses 71 54 70 63 50 82 88 83

Responsiveness of Staff 52 55 43 58 64 65 35 59

Communication with Doctors 55 69 81 53 54 57 52 76

Pain Management 54 70 84 68 68 75 64 76

Care Transition 87 80 82 73 70 81 87 85



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4. New Knowledge, Innovation and Improvements

Peer Review PilotResults of the 2014 AHRQ Safety survey revealed staff ranked SSM Health St. Clare's “non-punitive response to error” as 52.1% positive. In 2015, employees continued to identify the response to errors as a top priority, rating the “non-punitive response to error” slightly lower than the preceding year at 51.9% positive or the 75th percentile.

Beginning in March 2015, SSM Health St. Clare became a pilot site for a redesign of response to error within nursing. The vision of the pilot was that SSM Health St. Clare nursing peer review would provide the structure for nurses to assume responsibility and accountability for the quality of care provided to their patients. This discovery process leads to practice advancement, improved outcomes and continuous learning.

Clinical goals and safety survey are linked. To advance the outcomes, data would need to be brought to the bedside. Following the American Nurses Association peer review guidelines, the pilot integrated identifications of gaps in care, resolution to concerns critical to quality outcomes and acknowledged that nurses must share feedback on a consistent and constructive basis to ensure patient safety.

The pilot would take a two-phased approach:

1 ) Unit based champions 2) Event discovery reviews

Unit based champions encourage ownership for change and engage bedside employees.

New Knowledge, Innovation and Improvements


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The unit based champion pilot began by identifying infection prevention champions (IPC). The IPCs were guided by the infection preventionist through evidence-based literature, professional organization recommendations and industry standards. The IPCs were trained on the peer review model and how to give timely, focused feedback. In addition, they received education on how to interpret the data scorecard.

Monthly, the IPC and infection preventionist meet for 30 minutes to receive updated education, review data and plan their prevalence day audits. Prevalence days are focused on the data and evidence-based practice. IPCs are empowered to give real-time feedback and make changes on the spot. What cannot be changed immediately is discussed at the next meeting. All of these observations occur at the bedside.

After focused training, the IPCs met in December 2015 for their initial monthly meeting and prevalence day. The team identified that the hospital continues to have CAUTIs despite educational efforts and protocol initiations. In the first prevalence day, the team focused on insertion practice. Quickly, the team identified areas of opportunity from the OR to the inpatient units. They identified that solutions they were being asked to implement did not match the bedside nurses workflow or what was happening in their world. They identified parallel practices and how isolated changes put in place were affecting downstream practice, having both financial and clinical impacts.

The role of the IPC allows the employees to identify opportunities with process flaws impeding the ability to achieve best practice. Employees are empowered with the data and knowledge set to impact outcomes in real-time.

ED Blood Culture Contamination ReductionIn 2014, SSM Health St. Clare noted a steady rise in blood culture contaminations in the emergency department (ED), rising as high as 4 percent. The national benchmark is 2.5 percent. Blood culture contaminations can be the cause of inappropriate use of antibiotics. This can lead to increased costs from unnecessary medications given to the patient, misdiagnosis, potential admission, delays in surgery, unnecessary further laboratory tests or even the performance of invasive procedures, all of which can affect the patients’ overall care (Denno and Gannon, 2013) (Self et al., 2014).

An assessment of causes for contaminations was reviewed. Causes included re-palpating the venipuncture site, lack of education as well as knowledge of good blood culture blood sampling practice and no consistent process carried out by all employees.



16

The emergency department looked at ways to prevent contaminations which included:

• Increasing awareness of what can happen with a contamination.

• Use of an aseptic technique for skin preparation for the adequate amount of time, as well as the bottle preparation.

• Obtaining the correct amount of blood as the sample. The correct amount of blood for an adequate sample is 10-30ml for an adult. (neonates 1-2ml, 2-3ml for infants < 24 months, 3-5ml for older children and 10-20ml for adolescents) (Chew et al., 2013).

• Drawing the sample of blood for the culture from a separate percutaneous site — not with the IV start.

• Utilizing blood culture kits: One aerobic and one anaerobic bottle, alcohol wipe, chloraprep, sterile butterfly/vacutainer combo, tourniquet, sterile glove, info sheet on correct amount for an adequate sample per age and sterile 2 x 2's.

• Using a sterile glove (in case the site would have to be re-palpated) (Kim et al., 2011).

• Only trained staff may draw (NO STUDENTS).

• Consider calling the lab for difficult blood draws.

Changing the Process

The ED changed the blood culture collection process. Employees are more educated on this process and held accountable to follow the process. The research showed the importance of providing employee feedback, both positive and negative, re-educating when needed.

The process was changed to the following:

• Prepare your site and have everything you need ready.

• Clean the tops of the blood culture bottles with alcohol for 10 seconds each; allow to air dry.

• You can use the end of a pen to mark a “circle” in the place you want to stick, this will not be cleansed off.

• Cleanse the site for 30 seconds. This is your time to communicate with your patient, explain the importance of not contaminating the site and the reasoning for the two additional sticks.

• Wear sterile gloves. The evidence discourages retouching the site after cleansing, but if you do, the glove is sterile.

• Document the stick. Take ownership for doing a great job.

As a result, the emergency department has seen sustained results of contamination rates <2% for ten months.



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Documents

Nursing - SSM Health Nurses/… · Nursing Professional Practice Model ... • Inpatient cardiology/telemetry ... huddles, debriefs, SBAR and CUS words have been