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2018 BMC Nursing Annual Report

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2018 BMC Nursing Annual Report DEPARTMENT OF NURSING 2018 ANNUAL REPORT THE PRACTICE OF NURSING Chapter Title 2 PUBLISHED BY Boston Medical Center Department of Nursing PUBLISHER Nancy W. Gaden, DNP, RN, NEA-BC MANAGING EDITORS Greetings Colleagues, Diane Hanley, MS, RN-BC, EJD Erlyn B. Ordinario, MA It is with immense pride and appreciation that I share the 2018 Boston Medical Center Nursing DESIGNER Annual Report. I am awed by the accomplishments of our nursing staff. In the past 12 months, Ginny Warren we have lived our core values: Built on Respect, Powered by Empathy; Move Mountains; and Many Faces Create Our Greatness. This year, we completed our campus consolidation CONTRIBUTORS balancing the workforce challenges of this transition, the clinical needs of our patients, and our commitment to celebrating the legacy of our past. Busayo Ajayi Ann Carey Krissy Coffey We have experienced unprecedented growth in our patient volume requiring examination of Carol Conley how we provide exceptional care. Throughout our many challenges, we hold steadfast to our Gen Conlin core values and our ability to maintain a culture of respect, empathy, caring and compassion. Pamela Corey Our annual report provides examples of our work and highlights the professional nursing Kim Costello practice here at BMC. Christine DeAngelis Sarah Evans Patient care is optimized when nurses work together to deliver highly reliable care: care that is Maggie Faulds Doris Foley evidence-based and that results in continuous improvement in quality, with safety in our quest Eduarda Fonseca for Zero Harm. In this report, you will read about some of the outstanding accomplishments of Diane Hanley our nurses and interprofessional teams that have allowed us to progress toward our goals. These Donna Harvey efforts have resulted in decreased infections, improved medication safety, minimization of falls Joanne Hogan and enhanced transitions of care for our patients. Jennifer Jarbeau Allison Kaelblein So many of our nurses have fully embraced our shared governance structure; engaged in Cathy Korn Nicole Lincoln professional development and education; embraced peer feedback and accountability, and Amanda Martin participated in robust quality improvement, and evidence-based practice. I hope you enjoy the Maureen McMahon stories in this report that highlight some of this great work. Sheila Murphy Erlyn Ordinario Thank you for the expert, compassionate care that you provide for our patients and colleagues Jennifer Plummer and for leading the way in nursing excellence. Karin Rallo Steven Sainte With my sincerest appreciation, Geralyn Saunders Lisa Zani PHOTOGRAPHY Erlyn B. Ordinario, MA NANCY W. GADEN, DNP, RN, NEA-BC Senior Vice President and Chief Nursing Officer Boston Medical Center Introduction 1 Boston Medical Center Department of Nursing is Committed to Professional Practice Mission Statement Nursing Commitment EXCEPTIONAL CARE WITHOUT EXCEPTION to Professional Practice Boston Medical Center nurses are leading Boston Medical Center (BMC) has developed the improvement of health and health care and adopted a professional practice model that and strengthening the discipline of nursing serves as an underlying framework for all we through new knowledge, innovations, and do, unifying BMC nurses around a common improvements. Each day, front-line nurses belief system. It reflects the care nurses and nurse leaders in every corner of our provide to our patients, aligns with the BMC mission, and emphasizes BMC’s core values system of care are advancing professional BMC NURSING BY THE NUMBERS practice, clinical inquiry and the delivery of and overarching goals. BMC nurses consider evidence-based care to the patients, families, and incorporate those meaningful values and the communities we serve regionally, into each patient’s plan of care, ensuring nationally, and around the world. In that patients and families feel respected and YEARS OF EXPERIENCE RNS WITH BSN, partnership with patients, families, physicians, well-served. Additionally, nurses at BMC focus nurses, and other caregivers at Boston Medical heavily on providing culturally competent MSN, OR PHD care, creating goals and nursing interventions 71% Center provide a high level, consistent standard of care by identifying patient needs, that incorporate the cultural values important 45+ YEARS defining expected outcomes, and respecting to their patients and families. BMC nurses are committed to our care delivery model, patient- patient rights. Using the patient-centered RNS WITH care model, over 1,600 nurses in our system centered care, and shared governance, as 4% are driven to prioritize patient needs and both are core components of our professional 30–45 YEARS SPECIALTY demonstrate and deliver Exceptional Care practice model. 36% 11% CERTIFICATIONS Without Exception on a daily basis. 22% 10-19 YEARS 20-29 YEARS Pr ovation, ofession Inn al D ce, ev 20% 18% cti elo < 9 YEARS ra rity, Advoc p REGISTERED P nteg acy m d I en se t NURSES a n, Te , P B catio amw a e uni ork t c m , A ie 1634 m c n o co n e C Re u t id e are, spect n S v v C , C t a ti te u a f E c na ltu b e e io ra il t ff s ov l it y as ed G ernan V y E p ar ce a Sh lu m e ETHNICITY o s C Centered ent C ti ar Pa e CNAS & LPNS 74% WHITE 367 16% AFRICAN AMERICAN 5% ASIAN 4% HISPANIC OR LATINO ADVANCED PRACTICE 1% TWO OR MORE RACES 250 NURSES <1% AMERICAN INDIAN OR ALASKAN NATIVE OurNursing Nursing Professional Professional Practice Practice ModelModel* <1% NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER FEMALE 2 Boston Medical Center Nursing Department * Special thanks to the clinical nurses at Council Congress and throughout BMC who designed and implemented our nursing professional practice model. 90% BMC NURSING BY THE NUMBERS BMC by the numbers Patients BMC serves BMC’s innovative programs are nationally recognized models Busiest Emergency Department 70% are underserved minorities and make an impact on the social in New England, (60% black, 10% hispanic) 12th busiest nationwide determinants of health. 25+K 30% do not speak English as their 2018 INPATIENT ADMISSIONS 14 health centers in our network primary language Hunger Substance Abuse New England’s largest safety net hospital 50%+ have an annual household • Demonstration Kitchen Treatment and Prevention income below $20,400 (close to the 15th in the nation for NIH funding • Therapeutic Food Pantry • ABOVE (Psychiatry) federal poverty line for a family of 3) • Addiction Consult Service Homelessness 6000+ hospital employees • CATALYST (Adolescent 80%+ of patients are publicly insured • Elders Living at Home and Young Adult Care) BEDS 450,000 health plan members or uninsured • HUES to Home • FAST PATH Infectious 514 750+ Physicians Children’s Health Disease Care • Child Witness to Violence • Faster Paths to Treatment 817 Residents and Fellows OUT- • Office Based Addiction • Pieces of Home PATIENT 1,634 Nurses Treatment (OBAT) VISITS Urban Violence 1.1M+ • Project ASSERT • Violence Intervention • Project RESPECT Advocacy Program (VIAP) • SO FAR (Pediatric Care) ER VISITS 4 Boston Medical Center Nursing Department 132K BUILT ON RESPECT Patient Experience Percentile rank of communication between patients and 6W nursing POWERED BY Improving communication and patient experience is a major priority at Boston staff before and after Medical Center. As we considered the nurse handoff, which is an integral part of the daily routine of a nurse, we examined the change of shift report. While this part implementation of of the routine exists for all BMC nurses, the methods used in executing a handoff bedside reporting EMPATHY varied among nurses and across units. Historically, it has taken place away from the patient’s bedside and out of the patient’s room. The handoff had not typically included the patient, nor did it allow an opportunity for the patient to participate in their own care. After identifying the handoff routine as an opportunity to improve BEFORE AFTER the patient experience and patient safety, BMC adopted a standard evidenced-based tool called I-PASS. I-PASS, an acronym for Illness severity, Patient summary, Action COMMUNICATION plan, Situation awareness, and Synthesis, covers each of the critical components of 9% 64% WITH NURSES a verbal handoff. And, by moving the nursing report to the bedside, patients now have the opportunity to engage in their own care. Adopting this consistent method of executing the handoff, in addition to moving the action to the bedside, BMC has NURSES TREAT ME effectively improved communication, collaboration, and increased the level of respect 18% 55% WITH COURTESY shown to each patient. Patient safety is a focus of all we do and this mechanism of AND RESPECT bedside reporting is one of the tools we use to optimize patient outcomes. NURSES LISTEN 3% 77% CAREFULLY TO ME HCAHPS Patient Survey Results Clinical Outcomes The nurses at BMC are committed to Urinary Catheter Device Standardized Utilization Ratio continuous improvement of the delivery, 1.2 quality, efficiency, and outcomes of nursing practice. This continuous improvement is 0.9 accomplished by systematically collecting data, performing a review and analysis of that data, and using newly developed 0.6 knowledge to inform decision-making, evaluation, and implementation of 0.3 improvement activities to ultimately create a positive impact on patient outcomes. 0 2015 2016 2017 2018 BMC SUR GOAL < 1 CAUTI Despite its preventability, hospitals across the These best practices included: a nurse-driven The most important factor in reducing the risk Mother/Baby Discharge Planning Maternity Patient Experience country continue to struggle with catheter bladder management protocol to promote of catheter-associated urinary tract infection is associated urinary tract infection (CAUTI). early removal of catheters; use of a female limiting the number of days that a patient has Nurses on our Mother/Baby unit designed Patient experience in Maternity showed positive Pursuing the aforementioned improvements The National Healthcare Surveillance incontinence device in the critical care and a chronic indwelling catheter.
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