Nursing Annual Report 2020 - TriHealth

documentation process to deal with patients seen inAlternative Care Areas (ACAs).”TriHealth established 10 ACAs – COVID-19 testingsites next to six emergency rooms in the TriHealthsystem and four sites near primary care locations.Dozens of nurses who were not needed at the bedsidediverted their skills to working in these testing centers.Other nurses were furloughed and volunteered to dotemperature screenings on visitors entering TriHealthfacilities. Nurses also assisted with fitting N95 masks onproviders to protect against airborne particles.Cross-Training NursesAs some areas of the hospital increased patient activityand others decreased, unit-based educators pulledtogether essential skills required to cross-train nursesonto various units and into various roles.Nurse Educator Michael Osterbrock, BSN, RN-BC,Bethesda North Hospital MSICU/Progressive CareUnit/2-300 Telemetry, says, “Nurses from PACU [PostAnesthesia Care Unit], displaced nurses and CRNAs[certified registered nurse anesthetists] all jumpedin to help.” He worked with Cardiovascular IntensiveCare Unit Educator Cyndi Mapp, MSN, RN, CCRN-K,to assess people’s skills and train them to care forseriously ill COVID-19 patients or become runners toassist their bedside team members.They also trained people to perform pronationtherapy and to prevent pressure injuries in COVID-19patients on ventilators. Proning is a practice of movingpatients from their backs to their fronts to helpimprove oxygenation and ease breathing.Nurse Educator Brandi Shoupe, BSN, RN, CCRN,PCCN-CMC, and other nurses at Good SamaritanHospital were in frequent contact with Bethesda NorthHospital and recruited their own team of cross-trainednurses from Endoscopy, Catheterization Lab, PACU,Operating Room, Anesthesia, Emergency, Float Pooland Telemetry units.Missy Andres, BSN, RN, CCRN, SCRN, assistantnurse manager for the Neuroscience Intensive CareUnit at Good Samaritan Hospital, worked closely withMedical/Surgical ICU nurses. “The whole hospitalstepped up,” Andres notes. “Everyone was flexible. Wehad to get this done.”Nurse Educator Michael Osterbrock, Bethesda NorthHospital, trains nurses Tracey Palmer, Progressive CareUnit, and Lynae Young, Intensive Care Unit, on thehospital’s sepsis protocol, code readiness and how tooperate a Zoll monitor/defibrillator.“Not only have nursesdelivered on every challengethey’ve been tasked with,they’ve excelled at them.”– Sharon BrehmA Call to InnovateTo prepare for a surge in COVID-19 patients, Nursingcreated a Staff Modeling spread sheet that enabled theNursing team to easily explore various bed capacityand staffing availability situations per unit and hospital.It also auto-calculated a change in scenarios withina few minutes. The tool can be used should a surgeoccur in the future.When a national shortage of personal protectiveequipment (PPE) put providers at risk, BrandonBallhaus, BSN, RN, CNOR, Nurse Manager II ofPerioperative Services at Good Samaritan Hospital, andhis staff created masks from readily available materials.TriHealth’s Innovation Center conducted aneight‑week Bright Ideas COVID-19 campaignand nurses submitted 80 ideas. Some that wereimplemented included: Side shields for eye glasses to prevent virus particlesfrom entering the eyes Using a Dial-a-Flow IV tubing medical device toregulate the flow of medication without the needfor an IV pump. This saved Alaris IV pumps for morecritical patients A sticker on a patient’s clothing with the name andphone number of the person waiting outside thebuilding to take the patient homeWhen N95 masks became scarce in April 2020, Brandon Ballhaus and staff in Good Samaritan Hospital’s Perioperative Servicesused patient anesthesia masks with a PALL filter that filters out 99 percent of particles 0.3 microns or greater (COVID-19 is 0.5microns) and attached rubber bands to hold the mask in place.5

An Added Level of CaringExtraordinary times called for extraordinary responses.When state mandates called on hospitals torestrict all visitors, Good Samaritan Region ChiefNursing Officer Susan Macy, MBA, BSN, RN, recalls,“This was tough on our patients. Our nursing teamsbecame family to our patients. They helped celebratebirthdays, anniversaries and held our patients’ handswhen needed during difficult times. They filled thecommunication gap between our patients and theirfamilies. We utilized technology to communicatebetween patients and their loved ones.”Ila Frankel, RN, Care Management Coordinator atTriHealth Evendale Hospital, was furloughed duringthe quarantine but kept busy making masks with her13-year-old daughter. The duo created their ownpattern and donated the masks to TriHealth, Krogerworkers and teachers. “We wanted to do somethingmeaningful during our time at home while we weresocial distancing,” Frankel says.“Regardless of the challenges our nursingteams faced, they remained patient-focusedand professional,” Macy says. “The World HealthOrganization designated 2020 as the Year of theNurse, in honor of the 200th anniversary of FlorenceNightingale’s birth. No one could have predicted what2020 would bring. It’s no surprise to see TriHealthnurses rise to the occasion and face it head on.”Nurses and patient care assistants clean off personal protective equipment in between seeing patients on the COVID-19 floor atGood Samaritan Hospital. Liz Dufour/The Enquirer“This was tough on our patients.Our nursing teams became familyto our patients. They helpedcelebrate birthdays, anniversariesand held our patients’ hands whenneeded during difficult times.”– Susan MacyRenee Nash, Good Samaritan Hospital EmergencyDepartment, cares for a patient. Liz Dufour/The Enquirer6Nurse Christy Kelley administers care to a baby in the GoodSamaritan Hospital NICU. Liz Dufour/The Enquirer

TransformationalLeadershipThrough their vision, influence and clinical knowledge,nurse leaders use creative energy to solve problemsand develop innovative ideas.Leading by ExamplePerioperative Services DirectorSets High Standard at McCullough-HydeSandy Simpson, BSN, RN, CAPA, lives by the motto“Work hard, play hard.” The Director of PerioperativeServices at McCullough-Hyde Memorial Hospital inOxford, Ohio, values “being present and available tomy team to listen and communicate with them. I try tolead by example and stay positive.”During the difficult months of March throughJune 2020, as Ohio braced itself for the COVID-19pandemic, Simpson says, “I saw my team work at itsbest. Not only did our department pull together, butour hospital pulled together. Since elective surgerieswere canceled [to save supplies and hospital bedcapacity for a potential surge], I had team membersworking in other areas taking temperatures, trainingto work on inpatient units, working in oncology andsome even in building services.”She continues, “We worked together not only to takecare of our patients and our community but to takecare of each other.”Simpson became director of her area in May 2018and then took on additional duties as interim directorof Obstetrics in December 2018. She held both rolesfor several months and continues to mentor the newObstetrics nursing director, Maria Kreitzer, BSN, RN,CLC.She won a Preceptor of the Year Award from theGreater Cincinnati Health Council in 2009. In addition,one nursing studentwhom Simpson preceptedduring the transition fromstudent to clinical nursewrote these words tonominate Simpson forthe Healthcare Worker ofthe Year Award in Ohio.Written in 2009, thewords still hold true:“Anyone who interactswith Sandy will quicklynotice her passion forher career, co-workersDirector of Perioperative Services Sandy Simpson (center) discusses a patient case withand life. She brought aChaplain Timothy Tice and Care Manager Erika Scott at McCullough-Hyde Memorial Hospital.unique ‘glow’ to a placewhere work was verythe Inpatient SOAR [Serving Others Achieving Results]serious. Sandy never forgot a birthday or holiday, andteam since it started at McCullough-Hyde Memorialmade sure nobody did. She always brought friendship,Hospital.laughter and fun. I quickly noticed the high qualityThe most rewarding part of her job, she says, isof patient care and employee satisfaction related to“when patients call after their surgery and tell meSandy’s upbeat attitude and passion.”what a great group of people took care of them andSimpson encourages her team to become involvedwhat a wonderful experience they had. It’s also whenin committees, and to pursue education andsomeone finishes school, passes certifications, or iscertification. She studied along with her nurses tojust happy to come to work and enjoy what they do.get her Certified Ambulatory Perianesthesia (CAPA)That’s the reward of my WORK HARD goal.”certification this past year. She has been a member of7

Families Stay Connected Through Camerasin Neonatal Intensive CareTonya Johannemann, MSN, RN, NE-BC, Director of Perinatal Services, OB Float Pool,Fetal Care Team and Neonatal Intensive Care Unit (NICU) at Good Samaritan Hospital,experienced the hardship of having a grandson who needed surgery and intensive careimmediately after birth. While her grandson was at Cincinnati Children’s, she was ableto see him via an app connected to a camera. “This was our lifeline to see him, since hewasn’t always stable.”That experience sparked an idea to bring cameras into Good Samaritan Hospital’sNICU. Johannemann championed the project for more than two years and, in June2020, saw 60 cameras installed in the NICU. Now parents and family members cansign onto an app with a password and watch their little one any time when a nurse isn’tproviding care.“Our parents (and grandparents) are so thankful for the peace of mind this gives them,”she says. It has been even more valuable during the COVID-19 pandemic, which greatlyrestricted visitors for many months.Newly installed cameras over babies’ bassinets in the Neonatal Intensive Care Unit (NICU) allowa father serving in the military in Iraq to see his newborn son anytime through a phone app.Director of the NICU Tonya Johannemann (right) is with mom Kaitlin Pam and baby Soul to sharein the global connection.Advancing Nursing Practice Through Shared Leadership CommitteesShared Leadership Committees (SLCs) on nursing unitsthroughout TriHealth bring staff nurses together tospark ideas for improving patient care and the overallwork environment.In FY 2020, SLC accomplishments included:Bethesda North Region Bethesda North Emergency Department (ED)educated ED team members at Bethesda North andGood Samaritan hospitals on sepsis recognition anddocumentation. The SLC also identified strategies todecrease falls in the ED, including bedside shift report,fall audits, trialing stretcher alarms and foldablebedside commodes. They have also implementedan evidence-based practice on paracentesis fluidcollection by the ED nurses. 4-100 nursing unit improved documentation of intakeand output for heart failure patients. Minimally Invasive Surgery Center refined, organized8 and unified smart phrases in postoperativeinstructions to eliminate confusion, maintain aconsistent and professional standard of care andbetter educate postoperative patients.Thomas Center Infusion Center implemented pettherapy visits and invited a musician to play on theunit occasionally.Perioperative Services implemented daily huddles todiscuss next-day perioperative patient care needs.Special Care Nursery created a skin care protocol forconsistent, reliable practices for caring for diaper areaskin.McCullough-Hyde Memorial Hospital PerioperativeServices developed a pre-surgical checklist.Good Samaritan Region Medical Surgical Intensive Care Unit introducedadaptive equipment for critically ill patients to assistwith eating, writing and other daily living activities. Neonatal Intensive Care Unit created a ParentVisitation Contract, an infant-driven feeding scale andan audit tool for bubble continuous positive airwaypressure (bCPAP), a noninvasive respiratory support tohelp newborns with respiratory distress breathe easier. Presurgical Services provided iPads to educatepatients and family members as a patient is preparingfor surgery. The care team then answers additionalquestions. 8Q nursing unit developed a medication sideeffect form utilizing clip art to enhance patientunderstanding. A nurse reviews the form with thepatient and places it in the patient’s discharge folder. 12AB nursing unit developed table tents in patients’rooms to review the basics of hourly rounding,bedside shift report and other nursing services. Theinformation helped improve patient satisfaction topbox scores for hourly rounding and nurse leaderrounding.

Mother-Baby Unit Leader Implements SKIP RoundingWhen Nurse Manager Stacy May, BSN, RNC-MNN,Bethesda North Hospital’s Mother-Baby Unit, noticedher nurses were frequently getting called back topatient rooms just minutes after their hourly rounds,she began looking for another practice model.The SKIP model, recommended by a StuderGroup representative, caught her attention as amore effective method of rounding on a postpartumunit. FY 2020 was the unit’s first full year of the newpractice, which May describes as “purposeful hourlyrounds.”“We started using SKIP with our nurses and patientcare assistants. Then we added in others who dorounds: nurse leaders, lactation consultants, socialworkers and care coordinators,” May says.The different specialties coordinate their times sothey don’t overlap and constantly interrupt the newmoms. When they are finished, they sign a log thathangs on the back of the bathroom door.“As a nurse leader, I try to share feedback with thenurse in real time to let nurses know they are doinga good job or to make suggestions,” May says. “Weadopted champions respected by their peers to teachand role play SKIP.”The staff has noticed a decrease in calls asking foradditional supplies or an escort to the bathroom. “Wecontinue to listen to any feedback from staff,” Maysays, “because they’re the ones doing this every day.”As part of the SKIP hourly rounding program on BethesdaNorth Hospital’s Mother-Baby Unit, Staff Nurse Sharla Combschecks with a new mom to ensure she has all of the suppliesshe needs.The SKIP ChecklistEvery hour from 6 a.m. to 10 p.m. and every twohours at night (unless a new mom requests not tobe disturbed), each patient receives a visit from anurse who inquires about the following:S – Supplies – “We make sure our patients haveenough diapers, wipes, formula, blankets,water, pads and other essentials. The nursemay check the supply drawers just to be sure,”May says.K – Comfort – The nurse asks things like “Isyour pain OK?” “Do you need any pillows orblankets?”I – Information – When prompted, a momoften has questions on topics such asbreastfeeding, newborn care, getting a birthcertificate, or what to do about self-care andbaby care once at home.P – Personal needs met – “Our nurses ask if thewoman wants to talk about her feelings and,most importantly, say ‘I have time to talk.’”With this added invitation, many moms openup about what they are feeling.9

StructuralEmpowermentSolid structures and processes create an innovative environmentwhere professional practice flourishes, and relationships withthe community contribute to improved outcomes.TriHealth Nursing Advance Replaces Nursing RetreatDuring an Activity of Light, nurses symbolically burn theirpersonal lists of three obstacles to positivity.Speaker Bill Palladino encourages nurses to cultivate apassion for their jobs.With a focus on bringingpositive psychology to theworkplace, TriHealth Nursingchanged the name of itsevery-18-month “retreat” toTriHealth Nursing Advance.The first TriHealthNursing Advance tookplace in November 2019,with the theme “RekindleYour Passion for Nursing.”Featured speaker BillPalladino from theGoodThink organizationdelivered a message of happiness and positivity.During the day, nearly 250 bedside nurses and nurseleaders were encouraged to embrace what inspiresthem and remember what led them to pursuenursing.A large team of nurses and ancillary staff served on the TriHealth Nursing Advance Planning Committee.10The presence of more direct care nurses at theAdvance – about half of those attending – has been asignificant change over the years. “We can’t lose sightof how great it is to have the views and participationof direct care nurses,” says TriHealth Senior Directorof Nursing Administration Sharon Brehm, PhD, MSN,RN, ACNS-BC.Examining progress on the Nursing Strategic Planwas a major purpose of the event.“We’re at the midpoint of a three-year strategicplan, so we did a pulse check on how it’s going,”Brehm explains. “We shared some of the wins andasked people to give us ideas on some activities thathadn’t started yet. The emphasis was on fresh ideasand teamwork.”TriHealth President and CEO Mark Clementpresented information during the Advance, as didChief Nurse Executive Jenny Skinner, MSN, RN, andChief Nursing Officer Susan Macy, MBA, BSN.

Task Force Investigates– and Resolves –Rise in C. Diff CasesChief Patient Services Officer of McCullough-Hyde Memorial Hospital Pam Collins is pictured here (center right) with (left toright) Nate Chaney, Director of Quality; Maria Kreitzer, Director of Obstetrics; Mary Margaret Charles, Director of Education;Vickie Raible, Director of ED, ICU & Cardiology; and Sandy Simpson, Director of Perioperative Services.McCullough-Hyde Memorial HospitalNow Fully Owned by TriHealthTriHealth acquired full ownership of McCulloughHyde Memorial Hospital in Oxford, Ohio, in 2019.The nursing staff of the 45-bed hospital is ledby Pam Collins, MSN, RN, FACHE, Chief PatientServices Officer. The 150-member nursing team ispursuing Magnet recognition when TriHealth seeksrecertification in 2021. McCullough-Hyde MemorialHospital, which opened in 1957 adjacent to MiamiUniversity in Oxford, has been managed by TriHealthsince 2015.“In joining TriHealth, our nursing team membershave been able to receive support for advancement ofMultispecialty CenterOpens in Liberty TownshipThe TriHealth Liberty Medical Center in WestChester opened to patients in December 2019. Itoffers primary care services, orthopedics and sportsmedicine, hand surgery, OB/GYN, urogynecology,midwifery, neurology/headache and physical therapy.The center also houses TriHealth’s newest PriorityCare location for urgent care and offers X-ray andlab services. Fifteen TriHealth nurses, including RNs,LPNs and nurse practitioners, work on medical teamsthroughout the facility.their knowledge and skills by having access to ClinicalLadder, by receiving support for professional specialtycertifications and through networking with nursingcolleagues across the system,” Collins notes.“Our nursing leadership team has also developedleader skills, so as we work together, leaders havebeen able to best support our patient care teams.Our team member engagement is one of the highestwithin TriHealth. Our quality of care is the best it hasever been, and our patients are benefiting from theTriHealth Way.”A TriHealth system interdisciplinary task forceinvestigating increased cases of Clostridium Difficile(C. Diff) in 2019 found that they could improveaccuracy in tracking cases by switching the order ofC. Diff tests as patients are admitted to a TriHealthhospital. C. Diff is a highly contagious inflammationof the colon caused by bacteria growing as acomplication of antibiotic therapy.Any patient with a history of C. Diff or who has beenadmitted to a long-term care facility in the last threemonths now receives a polymerase chain reaction(PCR) test upon admission. This test determineswhether a patient has C. Diff bacteria in the colon. Apositive result confirms that C. Diff is present, but itmay not be active or contagious. Previously, the testwas given as a follow-up test, more than 72 hours afteradmission, and its positive result counted as a hospitalacquired C. Diff infection, even if it turned out to beinactive.If the PCR test result is positive, the staff followsup with an Enzyme Immunoassay (EIA) test on loosestool to determine C. Diff infection. The EIA testindicates whether patients are actively producingC. Diff toxins and, therefore, contagious.In October 2019, the new testing policy wentlive throughout TriHealth. The task force alsoimplemented a Best Practice Advisory in theelectronic medical record that fires when antibiotictreatment is needed.With the new pro

Susan Macy, Vice President and Chief Nursing Officer, Good Samaritan Region . Susan Macy, MBA, BSN, came to TriHealth in January 2019 as Director of Critical Care at TriHealth Good Samaritan . Hospital. Her previous position was Nurse Manager of Advanced Care Units at the now closed Good Samaritan . Hospital in Dayton, Ohio.