2017 Annual Nursing Report

2017 ANNUAL NURSING REPORT TRANSFORMING HEALTHCARE ONE PATIENT AT A TIME

Photography by Shawn Sprouse SDS Photography sdsimages.com sprouse.shawn@sdsimages.com 540-589-0724

Having Magnet status at our hospital is more than an award of nursing excellence. It is unity and teamwork, delivery of superior care to our patients, and having resources for continuing education to advance in nursing practice.

— Gale Helmick, RN Ambulatory Care Services

NURSING PROFESSIONAL PRACTICE MODEL

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TRANSFORMATIONAL LEADERSHIP

CNO Message In reflecting back over 2017, many of us would refer to it as “the year of surveys!” We had a successful Joint Commission Triennial Accreditation, Chest Pain Accreditation, Joint (Hip and Knee) Recertification, and Sepsis Certification. All of these recognitions help set our facility apart as one that delivers quality care. We ranked 20th (out of 142) in HCA for 2017 Clinical Excellence, which highlights our success with many indicators, including mortality reduction, sepsis, and hospital-acquired infections. We are a high- quality organization, and I thank all of you for the dedicated care you give to our patients.

Each of you, as strong nurses and leaders, have done an awesome job in continuing to provide quality care to our patients and supporting the hospital’s mission – “Above all else we are committed to the care and improvement of human life.” This facility has a strong vision for the future that is made more resilient by each of you and your daily contributions to nursing and the patient experience. Our primary focus for an exceptional patient experience, as well as improving the employee and physician experience, will continue throughout 2018. In order to attain these goals, you, as nurses, must continue to be the leaders. I appreciate your time and dedication to a great year for nursing at LGHM. It has been my pleasure to serve as your CNO for the past four years and to have worked at this facility for 23 years. I have watched the nursing culture change to one of shared decision-making and engaged nursing staff at all levels. I feel confident this facility will have a Magnet site visit this summer and will go on to attain our second Magnet re-designation – you should all be very proud of being a Magnet facility since 2009.

Please enjoy this annual report and reflect on the stories presented in it – stories that highlight a very successful year. My thanks and appreciation to every member of the nursing staff for the great care you give to our patients, as well as taking care of each other every day.

— Ellen Linkenhoker, MSN, RN, CNML

NURSE LEADERS Front row, left to right-Bitsy Musial, SS Director; Ellen Linkenhoker, CNO; Joy Gilman, Birthing Center Director; Jennifer Larkin, Cardiopulmonary Director; Back row left to right-Julie McElwee, ED Director; Marcia Mason, Quality Director; MJ Bean, Advanced Clinicals Director; Brady Lutz, ICU/ PCU Director; Christy Sutphin, Education/Magnet Program Director; Jennifer Redd, Clinical Operations Manager; Tara French, MSPO Director

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My role as a clinical documentation specialist focuses on ensuring that the acuity of our patients’ medical condition is captured through the specificity of medical record documentation. I believe that working in a Magnet facility enhances the team approach to patient care. When physicians are open to input from the entire team, they are better able to capture the patient’s true clinical picture in their documentation. When nursing staff are empowered, the entire facility benefits.

— Holly Marrow, BSN, RN Case Management

TRANSFORMATIONAL LEADERSHIP

CEO Message As we look back on 2017, we have focused a large amount of resources on experiences: patient, employee and physician. I continue to believe these are the correct areas to focus on in 2018. I think a large factor in our success has been the growth and development of our nursing leadership team. This nursing strength will be more important going forward than ever before. I believe our continued focus on the Magnet designation and shared governance model will guide the organization in the proper direction. This designation is maintained through the dedication and accomplishments of our nursing leadership. The strong leadership from our Chief Nursing Officer and our nursing councils has made it easy for this organization to take a leadership role around the Magnet strategies in our company. I want to take this moment to thank all of our nursing staff for their dedication and service to our community and patients. This year has started with one of the worst flu seasons in many years. With more admissions this year than last, the nursing staff is taking care of our community and patients with great care and precision. We are fortunate to have this nursing leadership right here at Montgomery.

— Alan Fabian, FACHE

Chief Executive Officer

EXECUTIVE LEADERSHIP TEAM Left to right-Marsha Myers, Chief Operating Officer; Alan Fabian, Chief Executive Officer; Tim Haasken, Chief Financial Officer; Ellen Linkenhoker, Chief Nursing Officer

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TRANSFORMATIONAL LEADERSHIP

Culture of Nursing Excellence/Magnet Program Director In 2017, LewisGale Hospital Montgomery completed and submitted a Magnet document filled with examples of transformational leadership, structural empowerment, exemplary professional practice and new knowledge. These sources of evidence illustrate why LGHM is a Magnet facility and provide examples of the extraordinary things nurses do here every day. I am extremely honored to work with each of you to develop this Magnet document and to assist in telling your stories. Only eight percent of hospitals worldwide are Magnet designated. LGHM is part of an elite group. There are 22 Magnet facilities in Virginia, and we are one of nine HCA facilities to achieve Magnet designation. Nurses at LGHM should be very proud of this accomplishment. As we move forward into 2018, we can expect a Magnet Site Visit and our second re- designation. I look forward to sharing in the excitement and celebrating this achievement with you. — Christy Sutphin, MEd, BSN, RN, Director of Clinical Education, Magnet Program Director 2018 Chief of Staff Working at LewisGale Hospital Montgomery is an honor and privilege. The collaboration between nurses and physicians is unlike anywhere I have worked before. The physicians on staff at our hospital truly feel a family-type atmosphere that is fostered at the bedside with our nursing staff. While we all know we are in a challenging time in healthcare, the nursing staff at LewisGale Hospital Montgomery understands the responsibility we have to care for our community. Time after time our nurses put their patients’ wellbeing in front of any other priority, and for this I want to say thank-you! — Greg Beato, DO, CAQ Sports Medicine 2017 Chief of Staff I am so proud to work with the nurses at LGHM. Our patients frequently express their appreciation for the excellent care they receive here. The dedication and experience is evident in the care provided. I have seen our nursing staff go far above the call of duty to be sure our patients are appropriately cared for in a variety of situations, such as bad weather with impassable roads. We, the medical staff, are honored to work with our nurses, and are so grateful for the work they do. — Stuart Gardner, MD

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Working at a Magnet facility means the world to me. As a nurse I know it means that my opinions and hard work are valued. It means that the organization takes the time to do what’s best for patients and the staff. I see the difference Magnet makes every day in the care that we deliver. I’m proud to work in a Magnet facility and know what a great honor that is! I know that it’s the hard work of all my colleagues that makes this possible.

— Samantha McClure, MSN, RN, PCCN Emergency Department

TRANSFORMATIONAL LEADERSHIP

New Nurse Leaders

Kim Mecom joined the LGHM Quality Department in 2017 as the Infection Preventionist. Kim graduated from Radford University with a BSN and received her MSN with an administrative focus from Waynesburg University. Prior to this role, Kim worked in a Trauma ICU at Wake Forest Bowman Gray for four years then spent the next 19 years of her career in the Emergency Department serving in several different roles (staff nurse, educator, manager and director). Kim enjoys spending time with her family, running, hiking, and baking.

Jennifer Rice was promoted to Manager of the Intensive Care Unit in August, 2017. She began working at LewisGale Hospital Montgomery on the Progressive Care Unit as a Patient Care Tech in 2005 and received her Associate’s Degree in Nursing from New River Community College in 2009. Jennifer worked on a pediatric cardiac unit in South Carolina before coming back to the Progressive Care Unit and the Intensive Care Unit at LewisGale Hospital Montgomery. Jennifer is currently working on her BSN through Chamberlain College of Nursing and is on track to graduate in 2018. She is also a member of the American Nurses Association.

Candice Blankenship was promoted to Clinical Coordinator of the Progressive Care Unit in October, 2017. She began working at LewisGale Hospital Montgomery on the Progressive Care Unit as an LPN in 2008 and received her Associate’s Degree in Nursing from New River Community College in 2011. Since becoming an RN, Candice has worked on the Progressive Care Unit and spent one year in Oncology at the Blue Ridge Cancer Care. Candice is currently working on her BSN through Liberty University and is on track to graduate in 2019. She has had extensive training in the administration of chemotherapy and biotherapy.

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New Nurse Leaders

Angie Johnson began her career at LewisGale Hospital Montgomery in the Birthing Center in 1996 as an OB Tech. She finished nursing school at Wytheville Community College in 1999 and transitioned to an RN in the Birthing Center. She received her BSN degree in 2014 from Western Governors University. Prior to being promoted to the Clinical Coordinator position in July 2017, Angie was a clinical team leader and a Daisy Award winner in 2013. She is mother of three wonderful children: Isaiah, Micaih and Sarabeth. Outside of work, she enjoys reading, crafts and adventures with her children.

Brady Lutz was hired as the ICU Manager in January, 2017, and transitioned into the role of ICU/PCU Director in June, 2017. Brady graduated from Jefferson College of Health Sciences in 2012 with his BSN. While working on his nursing degree, Brady volunteered as an EMT and worked as a nursing assistant. Brady’s clinical background was focused in critical care in a Neuro- Trauma ICU and in Surgical and Medical ICUs, but he also expanded his experience by spending some time in the Emergency Department. He received a Master’s of Science in Nursing with a dual focus on nursing leadership/ administration and education and he holds certification as a Critical Care Registered Nurse (CCRN) and Certified Emergency Nurse (CEN). Outside of work, he likes to spend his time with his family and dogs, and outdoors.

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TRANSFORMATIONAL LEADERSHIP

2017 HCA Excellence in Nursing Award-Compassionate Care: Michelle Keister, BSN, RNC The Compassionate Care Award is given to a nurse who demonstrates exceptional nursing knowledge and expert skills, and consistently applies both with compassion and integrity so that the quality of the care experience and care outcomes are improved for patients in any clinical setting or nursing specialty. Michelle has worked at LewisGale Hospital Montgomery’s (LGHM) Emergency Department for over two years, however, has been with LGHM since 2004. Michelle exemplifies compassionate care with every patient she visits. She is able to tactfully navigate through difficult patient experiences with a caring attitude and grace. Michelle is an engaged employee, active on hospital and unit based councils, a clinical ladder participant, and volunteers routinely in the community. Her dedication to her role and profession are evident in her daily interactions at LGHM. Frequently peers and patients comment on Michelle’s bright personality and excellent patient care. She has been nominated for the Daisy Award, a national award recognizing extraordinary nurses. She is always willing to help a coworker, whether it’s with taking an admission upstairs, doing a procedure or just holding a patient’s hand – she is there for all she works with and cares for. Michelle voluntarily floats to other departments when they are in need of assistance. She commented, on a facility social media page, about a recent float experience saying, “I felt tears as I sat and fed a frail women soup. I felt joy as I washed a woman’s hair, all the while (she was) thanking me because she hadn’t been able to bathe in three days. I felt humbled to know I could make a man smile by getting him coffee. I was truly able to experience the ‘good stuff’ nursing has to offer.”

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2017 HCA Excellence in Nursing Award — Professional Mentoring: Lori Short, BSN, RN

The Professional Mentoring Award is given to a nurse who advances nursing practice in any clinical setting or nursing specialty by guiding or supporting career development for individuals or groups of nurses or by advancing evidence-based nursing knowledge. I had no experience with Labor and Delivery and Lori took me under her wing to help me become comfortable in the craft. Lori always made sure that if there was something I hadn’t seen that I was there in the room. Even now Lori continues to help me and push me to do my best. She is always willing to answer questions and give me an opportunity to learn more. Since meeting Lori I have come to respect and appreciate her as a nurse and leader in this facility. She continually strives to ensure that the staff on our unit are giving 100 percent. Lori is frequently recognized by her co-workers as a fantastic mentor and clinical coach. In her peer reviews, the staff rave about her knowledge and her willingness and initiative to share that knowledge and help them to strive for excellence. Lori has oriented and continually pushes staff to be better each shift. You can frequently hear her quizzing staff and giving them scenarios that push staff to critically think and react. Lori is dedicated to her patients and wants the best for our moms and babies. In 2016, she accepted the role as Clinical Team Leader for night shift. She is always willing to come in and assist her fellow co-workers when things get busy. Lori performs mock drills independently with the night shift staff and is well respected on the unit as a leader and expert clinician. Lori deserves this award and would represent LewisGale Montgomery well because of all of these things, but mostly because of her commitment to excellence and her dedication to her fellow co-workers.

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TRANSFORMATIONAL LEADERSHIP

Catalyst Charge Nurse Courses: Cammie Kotz and Shannon Knowles

HCA Leadership Institute, Catalyst Learning Company and clinical educators work in partnership to bring the NCharge courses to staff nurses. These courses are designed to improve the leadership, management, and communication skills of charge nurses while reinforcing crucial business and return-on-investment measures. Through application of adult learning principles, each course promotes a high level of interactivity via case scenarios, video vignettes, and instructor-led discussion. Participants who complete all or portions of this series and apply the relevant skills and strategies will receive the tools to ensure smooth operation of a patient care unit.

LGHM active charge nurse completions (current as of 2/28/2018) are as follows: Charge Nurse Leadership Fundamentals: 98% Critical Thinking Skills for Charge Nurses: 53% Leading Change in a Dynamic Climate: 33% Supervisory Skills for a Positive Outcome: 35%

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Renovations In June, 2017, LewisGale Hospital Montgomery unveiled a newly renovated Emergency Department and formally introduced its new da Vinci Surgical System, marking the completion of more than $10 million in hospital infrastructure improvements as part of an investment announced last fall. More than $1 million in renovations to the Hospital’s 9,000-square-foot Emergency Department expanded the triage area where patients are assessed upon arrival. A new Super Track area was added where patients with lower acuity conditions are seen, leading to even faster patient care. The addition of the da Vinci Surgical

System offers patients an alternative to traditional surgical services, and one that provides for a faster recovery, less pain, and shorter period of physical restrictions, as compared to open or traditional laparoscopic surgery. Jason Fowlkes, MD, LewisGale Physicians, Montgomery Surgery Associates completed his inaugural minimally-invasive surgery in June using the new da Vinci robotic system. Additional improvements that were part of the $10 million project include: • More than $1 million in renovations and enhancements to the hospital’s 11,000 square-foot Surgical Department housing seven operating rooms, one of which was enlarged to accommodate the da Vinci robotic surgical system • $3 million toward the installation of a new energy management system that controls heating and air conditioning throughout the hospital with increased efficiency. The new system includes alarms that signal when temperature and humidity are out of range, which is particularly important in the Operating Room area • Major renovations to the 12,000 square-foot Progressive Care Unit on the second floor, where patients are closely monitored for blood pressure and heart rhythm, and additional renovations to the Cardiac Rehab and Respiratory Therapy area • Two new digital x-ray units, including one that is located in the ED Suite • Additional security system enhancements “Demand for quality healthcare services in the New River Valley continues to grow – particularly in the area of ER visits – in tandem with the growth experienced throughout Blacksburg and at Virginia Tech,” stated Alan Fabian, CEO, LewisGale Hospital Montgomery. “We’re better able to meet this demand – now and into the future – thanks in part to the renovations’ completion, the availability of new robotic surgery, ER wait times that are significantly lower than other emergency rooms, and the hospital’s Blacksburg location.”

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Working in a Magnet hospital means feeling supported and having a voice. It means having the opportunity to be involved in making changes for better patient outcomes.

— Jessica Martin, RN Birthing Center

STRUCTURAL EMPOWERMENT

Clinical Ladder and Career Advancement A primary focus for the Professional Development and Recognition Council is to provide oversight in professional nursing practice and support to the nursing staff. The Council has established and promoted a culture of learning and ongoing professional competency. Each year the Council celebrates new graduates of BSN, MSN, and DNP programs, as well as any nurse who attains certification in an area of nursing specialty. The Professional Development and Recognition Council also promotes the clinical ladder and works with all applicants through mentoring sessions. The Council ensures that all applicants have the resources to be successful in submitting and having their clinical ladder portfolio accepted at the desired level. This year, 87 percent of eligible applicants completed their submission. Congratulations to the nursing staff listed below who achieved this advancement in their professional career:

Level 3 Leslie Combs Anna Coburn Kat Irizarry Sabrina Rutledge Bradley Scott

Level 4 Heather Harry

Level 5 Susan Huffman Michelle Keister Devin Lapuasa Samantha McClure Cindy Sprague Chelsey Williams Robert Heins Shannon Knowles Margaret Gichana Anabelle Eberhardt Jessica Freer Christie Wright Miller Rosalie Mendoza Carrie Estes Darla Hill

Margaret Crigger Melissa Sheppard Michelle Linkous Kim Villar Karissa Mays Andrea Brunner Sean McGrady

Erin Moretz Karol Jarvis

Alysia Hodge Marcia Chew Adrienne Shepherd Katrina Zody Mike Hill Gale Helmick Christina Samples Christie Cunningham Lori Short

Lisa Robertson Kim Woodard Jennifer Poole Angela Johnson

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STRUCTURAL EMPOWERMENT

2017 Certified Nurses National Certified Nurses’ Day was celebrated in March, 2017, by holding the fifth annual Spa Day. The day offered an atmosphere of relaxation and pampering, including massages, hand paraffin, snacks and raffle drawings. LGHM’s certified nurses are:

Alice Ashwell Amanda Devaney Ana Bella Eberhardt Andrea Brunner Angela Johnson Angelina Heim Anne Taylor Ashley Day-Costa Brady Lutz Candice Blankenship Carolyn Newman Carrie Estes Chelsey Williams Christie Wright-Miller Christine Green Crystal Robertson

Dorothy Dalton Elizabeth Meek Ellen Linkenhoker Emily Matherly Erin Yoder Jay Pappas Jean Duetsch Jennifer Redd Jennifer Poole Jennifer Larkin Jessica Freer Joy Gilman Julie McElwee Karen Worrell Kimberly Woodard Kimberly Villar Kimberly Mecom Kristi Linkous Laurie Turner Leslie Combs Lisa Robertson Lisa St. Clair Marcia Mason Margaret Gichana

Margaret Crigger Maribeth Coluni Melanie Davis Michael Dunbar Michelle Gallimore Michelle Keister MJ Bean Rebecca Frame Robert Heins Rosalie Mendoza Samantha McClure Shannon Knowles Sharon Ratcliffe Susan Huffman Tara French

Teresa Kenyon Terri Bateman Vicki Krug Whitney Armor Yvette Kerr

Cynthia Walker Cynthia Sprague Darla Hill Debbie Vest Dee Hawthorne Devin Lapuasa

Diane Gully Don Yearout

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Magnet empowers nurses to have a voice and to use that voice to improve care for our patients and community.

— Brad Grigg, RN Supervision

STRUCTURAL EMPOWERMENT

LGHM Middle School and High School Camps At a time when healthcare workers are in short supply it has never been more important to provide opportunities for the young people in our community to get an up-close look at healthcare careers. LewisGale Hospital Montgomery (LGHM) offers this opportunity to both middle school and high school students who have an interest. Camp Montgomery is a weeklong summer camp designed to give middle school students a behind-the-scenes look at a variety of hospital careers. Students explore nursing at all levels and gain insight into the daily activities of lab technicians, pharmacists, radiology technicians, and physical, occupational and speech therapists. The LGHM Nursing Career Camp targets high school juniors and seniors who want to learn more about nursing. A visit to the Radford University Nursing Simulation Lab allows the students to experience how university nursing students learn. Students are exposed to a variety of specialty nursing roles, including the role of the advanced practice nurse in the Emergency Department and in the Operating Room. The first camp was held in 2009 and interest in the camp remains high. LGHM nurses were asked if the camp should continue, since many of the nurses who share their talents with the camp are already working long hours. The response was a resounding, “yes!” LGHM nursing staff enjoy sharing their clinical expertise and passion for nursing, and they take great pride in the part they play in developing the future of nursing.

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Magnet Champions In 2017, the Magnet Champions took their creativity for educating the staff to a new high. The Magnet Champions kicked off the spring with a very successful Easter egg hunt! Committee members donned their bunny ears and hid eggs throughout the hospital, resulting in housekeeping taking the first-place prize of finding the most eggs and answering the most questions correctly! In the summer, the champions utilized the newly constructed LewisGale Hospital Facebook page and created a fun, selfie scavenger hunt highlighting why staff love working at this facility. With this scavenger hunt, the champions created their own hashtag, #lghmmagnetize, to organize all the magnet events that would be taking place at the hospital. In the fall, the champions pulled out the tried and true Magnet cart! The “super” champions rounded on both day and night shifts, educating the staff on the patient care delivery model and Patient and Family Center Care, in addition to shooting down super heroes with nerf guns and punching a blow up spider man with Hulk hands! To round out the year, the champions again utilized the employee Facebook page. They made videos targeting the 12 Days of Magnet, asking questions in their videos for staff to post answers. The videos were both fun and educational! The champions used entertaining new ways to educate the entire hospital about our Magnet journey. In anticipation for an upcoming site visit, the Champions will continue their successful journey into 2018 with more creative, enjoyable games and activities.

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STRUCTURAL EMPOWERMENT

Shared Governance Councils

Nursing Informatics Highlights: • EBCD implementation • IV Drip Titration Intervention • Controlled Substance Handoff Intervention • TeleTracker change to BMAC

Professional Development and Recognition (PD&R) Highlights: • PD&R awarded three certification scholarships in 2017 to Lori Short, Erin Moretz and Jennifer Snediker.

• The council implemented “Random Snacks of Kindness” with council members rounding on nursing units in appreciation for all nurses do for our patients every day.

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Shared Governance Councils

Professional Practice Council Highlights: • Reviewed and maintained nursing policies • Conducted annual review of Professional Practice Model (PPM) • Educated nurses regarding Patient and Family-Centered Care PPM

Nursing Research Council Highlights: • Promoted dissemination through the internal Poster Fair with 21 posters accepted • Submitted 13 abstracts to external conferences • Council members assisted with planning and hosting LGRHS Annual Research Day

Nursing Improvement and Clinical Excellence (NICE) Council Highlights: • Created and implemented a nursing peer review process focused on decreasing falls and improving inpatient diabetes management • Conducted audits to improve bedside handoff

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I have had the opportunity of longevity in a career that has offered intellectual depth and variety, strength of purpose, and last, but certainly not least, being in service to others. The facility Magnet journey

brings these nursing career aspects into sharp focus.

— Cammie Kotz, BSN, RN Education

2017 Heart Chase On October 14, 2017, LewisGale Montgomery collaborated once again with the American Heart Association for the annual HeartChase/Heart Walk event. This event started in the New River Valley in 2014 and has nearly doubled in size each of the last four years. The event raised over $65,000 and we had over 500 volunteers show up to participate. The hospital had 11 teams registered in 2017. This is a high energy and competitive event with many of our nurses from LewisGale Montgomery being at the top of the winner’s board year after year. While the HeartChase/Walk event is great fun, it also means so much more to our community. The money raised by this event goes towards supporting the American Heart Association’s mission of Heart Disease and Stroke prevention and education. LewisGale Montgomery’s dedication to this event through sponsorship and participation prove that we live our mission each and every day. Above all else, we are committed to the care and improvement of human life. STRUCTURAL EMPOWERMENT

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STRUCTURAL EMPOWERMENT

Partnership with Goodwill Industries of the Valleys In 2017, LGHM partnered with Goodwill Industries of the Valleys and FastTrack Healthcare Education to provide a meeting space to conduct Certified Nurse Aide Classes. 26 students participated in the program, and had an 82 percent pass rate on the Certified Nurse Aide exam offered through the Virginia Board of Nursing.

Welcome Nurse Residents LGHM launched its first HCA Nurse Residency Cohort in 2017. Nurse Residency is a yearlong, extensive clinical orientation and professional development program. Participants in the program work side-by-side with a preceptor and have the opportunity to observe a wide variety of interactions with patients and family members, as well as develop clinical skills. The program includes monthly meetings with a mentor, educational seminars and an evidence-based capstone project. Dianna Orndorff and Aaron Wiley are participants in the first cohort and are scheduled to graduate from the Nurse Residency Program in 2018.

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I feel that working in a Magnet hospital reflects on me personally and professionally in numerous ways. A Magnet hospital is a facility that employs nurses who provide superior nursing care to ensure excellent patient outcomes and reflect high levels of job satisfaction. Having a strong nursing credentialing program like Magnet will help us and our nation to address the nursing crisis and continue to provide and improve nursing care.

— Laura Shelton, RN PACU

EXEMPLARY PROFESSIONAL PRACTICE

Pursuing Clinical Excellence in 2017 Clinical Excellence was a major focus for our facility to decrease healthcare-associated infections, healthcare-acquired conditions, and mortality, and to maintain compliance with core measures (90% expectation). The “Aim for Zero” campaign was set as our roadmap to success. The Infection Preventionist’s role was one of surveillance, performance improvement to reduce HAIs, acute response to potential or actual outbreak investigations, education training for healthcare personnel and patients, public reporting, and regulatory and accreditation activities. Kim Mecom’s role as infection preventionist had the expectation for daily rounding with concurrent feedback to staff to promote and communicate effective implementation of infection-control strategies.

QUALITY DEPARTMENT Front row left to right-Janice Cheverton, Marsha Mann, Marcia Mason, Debi Potter Back row left to right-Brenna Williams, Ashley Day-Costa, Kim Mecom, Katina Gee, Elizabeth Ryan, Christie Jackson

So—how did we do?

2016

2017

Improvement Noted

Hand Hygiene

93.8%

94.25%

YES

CHG bath

84.3%

89.16%

YES

Mupriocin

91.3%

93.4%

YES

MRSA

0

0

N/A

VAE

13.81

15.97

No

CDIFF

5.82

7.33

No

CLABSI

0.82

1.58

No

CAUTI

0.716

1.54

No

SSI Colon

6.89

0

YES

SSI Hyst

0

0

N/A

HACs

2

2

N/A

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Falls Reduction Efforts The challenge of fall prevention involves managing a patient’s underlying fall risk factors and optimizing the hospital’s physical design and environment. A 2017 focus for the Nursing Improvement and Clinical Excellence Council was evaluating how to minimize falls (and more importantly injuries related to falls). Elizabeth Ryan, Risk Manager, and Tara French, NICE Director Liaison, accomplished several operational changes to facilitate reductions in our inpatient falls. • Bed cables and Y-connectors for the bed nurse call button to interface with the nurse call system • During the renovations, new ceiling tiles were placed (one to every patient room) with “Call, Don’t Fall” printed in yellow above the bed • Patient Education brochures on falls developed and implemented house-wide • Review of case studies in NICE Council focusing on opportunities for nursing care improvement related to actual falls • Education to staff on patients at risk for falls and safe patient management processes • Revision and re-education of post-fall huddles With this increased attention to falls during 2017, there was a 26 percent reduction in inpatient falls and an eight percent reduction in the rate of patient injuries from falls. This was a positive outcome for our patients.

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EXEMPLARY PROFESSIONAL PRACTICE

2017 Daisy Awards Winners The Daisy Award is a nationally recognized award established to recognize extraordinary nurses who make a difference in the lives of so many people by the super-human work they do every day. It rewards and celebrates their superior clinical skill and compassion. The Daisy Award was established in 2000 by the family of J. Patrick Barnes. Prior to his death, Patrick’s family was awestruck by the care and compassion his nurses provided to not only Pat, but to everyone in his family. One of the goals the Barnes family set in creating the foundation in Pat’s memory was to recognize extraordinary nurses everywhere (www. DAISYfoundation.org). “The Healer’s Touch” statue is hand-carved out of Serpentine Stone by an African sculptor. The sculpture’s unbroken lines represent the bond between the caregiver and the patient – always flowing, always caring.

Jennifer Poole, MSN, RN, Birthing Center 1st Quarter, 2017 Jennifer Poole’s nomination was submitted by a new mother who stated that, “Jen went above and beyond for me and my little family. She treated us so good – always helped when needed and made a very good impression on us. She went with me to my C-section and I was so nervous I thought I couldn’t do it. She stood in front of me, held me as I received my spinal, and she stepped me through all my anxiety. She is such an amazing nurse and I couldn’t have done it without her. She helped with my skin-to-skin and was amazing to my whole family!”

Carla Harris, RN Intensive Care Unit 2nd Quarter, 2017 Carla Harris’ nomination was submitted by a coworker who was impressed by the care Carla provided for an elderly woman with metastatic cancer. When the patient was told late in the day that her condition was terminal, she wanted to go home to be with her cats. Carla was told that Hospice could not be set up so late in the day, but she did not give up. She spent two hours on the phone with Hospice to get the patient home. The patient went home that night. Later, the patient’s husband came back and said his wife died the next day, with her cats. He was so appreciative of Carla and said he had made a new friend.

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Devin LaPuasa, BSN, RN, Emergency Department 3rd Quarter, 2017 Devin LaPuasa’s nomination was submitted by a coworker who described her extraordinary efforts to comfort a trauma patient in the ED. The patient had been in a motor vehicle accident which resulted in his wife passing away right beside him. He was not seriously injured himself, but was understandably extremely distraught. Devin was able to establish a rapport with him and learned that his dog was in the car and had survived the accident but had been taken to the animal shelter. Devin gained approval from administration to bring the dog to the patient. She personally went to the shelter to get the dog (arriving just before they closed), and set up the ED Doctor’s Room for the dog and patient to stay together until his family (still hours away) could arrive. Devin gave up much of her personal time with her family to help make the patient’s worst day of his life a little better. When the patient saw the dog, there was not a dry eye in the room. Before leaving later that night, the patient expressed how truly thankful he was to Devin and how happy it made him to have his dog there with him. Angela Johnson, BSN, RN Birthing Center 4th Quarter, 2017 Angela Johnson’s nomination was submitted by one of our OB/GYN physicians whose patient was admitted to the Birthing Center with respiratory arrest. The patient was extremely difficult to treat and stabilize and ended up in the ICU. Angie recognized the urgency of the situation for this patient who was 32 weeks pregnant and contacted the physician. She remained calm even as the physician admittedly was “barking out orders left and right – changing orders as the patient and her husband allowed.” The physician stated that Angie never complained, criticized, or lost her professionalism and she helped the physician save this patient. “Without her dedication to help me treat this patient, there would have been a very different outcome. She is an asset to this unit.”

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EXEMPLARY PROFESSIONAL PRACTICE

Designations Chest Pain Center Re-Accreditation LewisGale Hospital Montgomery was first accredited as a chest pain center (CPC) in 2009, with subsequent re-designations in 2011, 2014, and again in March, 2017. We choose to pursue this accreditation because we, along with the Society of Cardiovascular Patient Care, are striving to eliminate heart disease as the number one cause of death in our world. To do this, we need to be on our toes, and measure and track everything, from the initial 9-1-1 call, through hospitalization, to the rehabilitation process post discharge. Accreditation is our way of ensuring the science of cardiovascular care reaches our patient’s bedside and positively impacts quality outcomes. This version of CPC accreditation had us focus on the following: • Governance: Making sure we have the right leaders, equipment, and facilities • Community Outreach: Ensuring our message is out there, especially as it relates to the less-than-obvious signs of acute coronary syndrome, and the need to call 9-1-1 if a heart attack is suspected • Pre-hospital: Our relationships with our EMS providers are absolutely essential • Early Stabilization/Acute Care: What are our pathways, order sets, processes, policies, etc. to make sure every patient gets high- quality rapid assessment and treatment throughout their time with us? • Transitions: How do we get folks back into their productive lives after an event? • Clinical Quality: We track and trend many metrics for chest pain, STEMI, and NSTEMI patients None of this would have been possible without the dedication of all of the medical, nursing, and ancillary staff involved in the care of this patient population. Thanks for being part of our journey! Sepsis Certification LGHM earned the Gold Seal of Approval for Sepsis Certification from The Joint Commission. The Gold Seal of Approval is a symbol of quality that reflects an organization’s commitment to providing safe and effective patient care. The Joint Commission survey evaluated compliance with national, disease-specific care standards as well as sepsis-specific requirements. A team, led by Ashley- Day Costa, Sepsis Coordinator, made great strides in reducing mortality across the population, showing compliance with evidence- based care bundles, patient satisfaction, and patient education outcomes. This achievement signifies a Culture of Clinical Excellence across our organization, with teamwork and collaboration to drive performance. Total Joint Re-Certification LGHM achieved Orthopedic Joint Re-Certification from The Joint Commission in October, 2017. During this survey, we were able to highlight best practices in regards to elective hip and knee replacements. Joint Camp, a pre-education class, is offered three times a month with 92 percent of all elective joint replacement patients attending. Joint Camp has been instrumental in educating patients about the establishment of reasonable pain goals and activity expectations. 90 percnet of elective joint patients are mobilized within four hours post-operatively, decreasing length of stay to 2.2 days and improving overall outcomes.

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Trauma Symposium Prevention of traumatic injuries is key to the health and wellness of the communities in Southwest Virginia’s New River Valley. The purpose of the Trauma Symposium 2017 was to heighten participants’ competence by providing the most up-to-date developments in research, diagnosis, treatment, and management of various trauma aspects. The overall goal was to engender positive patient outcomes, professional development opportunities, and expanded clinical practice guidelines for trauma care. There were 128 attendees, and a total of 342 contact hours of Continuing Nursing Education was provided. 20 percent of the nurses self-reported dual affiliations and roles as both clinical nurses (hospital) and EMS personnel (pre-hospital). “Teamwork makes the dream work,” is a bit cliché, but through the collaborative efforts of the interdisciplinary planning team, Trauma Symposium 2017 was a success.

Companion Animal Comes to LewisGale Hospital Montgomery “Meet Rollie, Our Newest Volunteer” Rollie is a graduate of the Canine Companions for Independence non-profit organization in New York. She is a Volunteer Assistance Dog who knows over 40 commands. Rollie loves her squeaky toys, food, swimming and having her belly rubbed. Rollie started visiting patients at LGHM in September, 2017, and has been a major hit with patients and staff alike.

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Nursing gives us the opportunity to make a difference in the world. We are there to care during the best and worst times. Being a part of a Magnet facility allows us to offer the best care possible to our patients.

— Heather Harry, RN Medical Surgical Pediatric Ortho Unit

EXEMPLARY PROFESSIONAL PRACTICE

New Equipment and Software Upgrades LGHM is committed to providing nurses with the necessary tools and equipment to do their job, and ensure safe, quality care for our patients. Many upgrades were implemented in 2017 to help make our nurses’ day-to-day activities a little easier. EBCD Evidence-Based Clinical Documentation (EBCD) went live in November, 2017. EBCD is a new way of thinking about clinical documentation and creates a patient-centric record in MEDITECH. This record guides and informs the provision of safe, effective and efficient care by the interdisciplinary team and produces data to evaluate the care of individuals and patient populations. LGHM implemented EBCD to increase nursing time at the bedside, improve communication of patient information through streamlined and shared documentation, improve patient safety and satisfaction, and to provide more meaningful and concise clinical documentation. New Vital Sign Machines In April, our facility began using 22 new Welch Allyn Connex Spot Monitors for vital signs measurement and Modified Early Warning System (MEWS) scoring. The monitors allow for automatic vitals and MEWS scoring to be sent to the Electronic Medical Record (EMR) from the point of care. While this technology is not new to LGHM nurses, all were excited about the upgrade and the machines’ speed. Pyxis ES As part of an HCA Capital Division rollout, the LGHM Pyxis ES software conversion in June, 2017, brought to the nurse simple, efficient, and safe workflows that are patient-focused. A few highlights this software brings to the care arena include: • Workflow efficiencies with single sign-on • Ability to find patients anywhere in the facility • Fewer steps to remove a medicine • Ability to quickly locate meds throughout the facility

• Discrepancy screens provide more details for easier resolution • Availability of more medications in MedStation ES with less time wasted hunting for meds and pertinent information • Medication safety enhancements, such as duplicate patient name alerts, expanded dispensing information, interactive notification of undocumented waste, and override med checked against profile IV Pumps

In November, 2017, LGHM received 184 Baxter Sigma Spectrum Devices. These pumps are smaller and lighter and are designed to be safer for our patients with an average of 97 percent usage of the drug library. A human factors simulated-use study with sigma spectrum pumps revealed a 99.1 percent overall success rate across all user groups. The IV pump conversion was led by nurses in the facility and resulted in 80 percent or greater of staff on each unit trained prior to go-live.

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EXEMPLARY PROFESSIONAL PRACTICE

Nurse Recognition BLACKSBURG (WSLS 10) – Our 2017 Red Cross Medical Hero works 40 hours a week as an RN in the Emergency Department, but also volunteers as a paramedic. Chelsey Williams said she knew at 16 years old, when she tagged along in the ambulance to her very first call, that her future profession would be in the medical field. “Every time you run a call you’re seeing someone probably at the worst moment of their life when they call 911, so every time our truck goes out the door we’re always making an impact. Just knowing that every time you are here doing something like this, it is a very fulfilling job,” said Williams. 10 years later, she is still volunteering with the Blacksburg Rescue Squad, running calls 40 hours a week. “We don’t get paid for it, so this is truly just out of the kindness of our hearts that we get to give back to our community,” continued Williams. Last Christmas season, she ran a call and unfortunately the outcome was fatal. “The family was left without a provider and caretaker. We heard about this and knew that this family was in need and it would be nice to give them Christmas presents,” recalled Williams. Chelsey and one other member used their own money and bought presents for the kids. When asked why she decided to help, Williams answered, “because that’s what you should do and if it were my family I would want someone to help my family and my kids. Really that is what Christmas is about – being able to give back. I’m blessed and fortunate to be able to give back.” Chelsey and others didn’t just drop the gifts off at the door, they delivered them with Santa and a deputy escort. “I can’t describe how excited their faces were when they actually saw Santa get out of the ambulance and he had his big sack over his shoulders delivering them presents. It just really takes you back to when you were a kid,” said Williams. “Just their faces, it was just pure happiness and excitement and I think that made it all worth it right there in that perfect moment, that made my Christmas.” Her hard work saves lives, but her heart helped save Christmas for a grieving family, making her a hero.

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We began the Magnet journey as a way to recruit and retain nurses but it became so much more. The committees have given the nurses a voice, improving nurse satisfaction and more importantly patient care. We as nurses have initiated evidence- based policies, self-scheduling, unit rounding for care that is more cohesive, and nursing satisfaction initiatives. The committees have given nurses the power and ability to impact almost every aspect of patient care, and more control over how their job affects their personal lives. I am proud to be a part of a Magnet facility.

— Carolyn Newman, BSN, RN Intensive Care Unit

NEW KNOWLEDGE, INNOVATIONS, AND IMPROVEMENTS

Continuous Passive Motion: What Does the Literature Say? Shannon Knowles, BSN, RN, and Margaret Crigger, RN

Expanding Progressive Mobility in the Intensive Care Unit through an Interdisciplinary Team Approach Brady Lutz, MSN, RN

Promoting a Smooth Transition: Delaying the Newborn Bath Angela Johnson, BSN, RN, and Jennifer Poole, MSN, RN

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Implementation of a Pre-Hydration Protocol to Prevent Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention Jennifer Larkin, MSN, RN, and Cynthia Walker, BSN, RN

Impacting Sepsis through Pre-hospital Collaboration Julie McElwee, MSN, RN, and Ashley Day-Costa, BSN, RN

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HCA Innovator’s Award Great products, services and companies often begin with a single idea. HCA was created through the vision of our founders, Dr. Thomas F. Frist, Sr., Jack Massey, and Dr. Thomas “Tommy” Frist, Jr. More than 45 years later, our company continues to invent and develop systems to advance health and patient care, in large part, due to ideas from the employees. The Innovators Award continues the tradition of recognizing innovative thinkers. Innovators Award ideas may be submitted at any time in one of three categories: Quality/Patient Care • An idea that improves clinical outcomes • Facilitates public recognition for quality or performance NEW KNOWLEDGE, INNOVATIONS, AND IMPROVEMENTS

• Improves use of clinical resources • Reduces employee health issues Service Excellence • An idea that enhances the patient, physician, or employee experience • Improves satisfaction or loyalty scores

• Supports diversity Financial Impact

• An idea that results in measurable expense reduction • Enhances patient care management to reduce risk • Produces increased volumes • Enhances reimbursement or revenue-loss avoidance Innovator Award Eligibility and Process • Any full-time HCA employee may submit their ideas in consideration for the Innovator Awards • Recipient may be an individual, a team, or a department • Final judging and selection of the national award recipients will be done via a selection committee made up of corporate employees

HCA Innovator Award Joy Gilman, Director of Women’s Services, is this year’s LGHM Innovators Award winner in the category of financial impact. Employee turnover is a significant cost for any business. This makes turnover an excellent place for innovations with both a personal and financial impact. Specific highlights around Joy’s submission include a unique view of the employee experience, particularly those new to our facility. By taking a holistic approach to employee onboarding, Joy incorporates her team in the welcoming and integration process, adding multiple touchpoints so that incoming staff feel welcomed and included. For addressing issues that arise in the first-year experience, Joy also incorporates a root-cause analysis approach to discovering learning opportunities for unit development and improvement, all which continue to create a positive environment for staff.

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2017 Research Studies Assessment of Nurses’ Health Risk Factors and Health-Promoting Behaviors at LewisGale Hospital Montgomery Margaret Gichana, MSN, RN-BC; Samantha S. McClure, MSN, RN, PCCN; and Rebecca C. Clark, PhD, RN. The purpose of this study was to identify health risk factors and health promoting behaviors used by nurses at LewisGale Hospital Montgomery (LGHM). 2017 Poster Presentations • Diane Gully, MSN, RN, One Step at a Time: A Multidisciplinary Intraprofessional Approach to Fall Prevention. LGRHS Annual Research Day. Blacksburg, Virginia. April 2017. • Christy Sutphin, MEd, BSN, RN, and Chris Green, RN, Interprofessional Approach to Decreasing Hypoglycemic Events. LGRHS Annual Research Day. Blacksburg, Virginia. April 2017. • Julie McElwee, MSN, RN, and Ashley Day-Costa, BSN, RN, Impacting Sepsis Through Pre-hospital Collaboration. Virginia Nurses Association Fall Conference. Hot Springs, Virginia. November 2017 • Jennifer Larkin, MSN, RN, and Cynthia Walker, BSN, RN, Implementation of a Pre-Hydration Protocol to Prevent Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention. Carilion Nursing Research Conference. Roanoke, Virginia. November 2017. • Shannon Knowles, BSN, RN, and Margaret Crigger, RN, Continuous Passive Motion: What Does the Literature Say? Carilion Nursing Research Conference. Roanoke, Virginia. November 2017. • Brady Lutz, MSN, RN, Expanding Progressive Mobility in the Intensive Care Unit through an Interdisciplinary Team Approach. Virginia Henderson Nursing Research Symposium. Lynchburg, Virginia. November 2017. • Angela Johnson, BSN, RN, and Jennifer Poole, MSN, RN, Promoting a Smooth Transition: Delaying the Newborn Bath. Virginia Henderson Nursing Research Symposium. Lynchburg, Virginia. November 2017.

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