Spotlight On: Evidence Based Medicine Program Nurses
Read how Crozer-Keystone nurses are working to implement evidence based medicine initiatives across the healthcare system.
Suzanne Jenkins, RN, BSN, EBM project coordinator at Crozer-Chester Medical Center, was spotlighted in the May 2009 issue.
Annmarie Birmingham, RN
Throughout her 32-year nursing career, Annmarie Birmingham, RN, has fulfilled many roles, from caring for patients in Crozer-Chester Medical Center’s Emergency Department and Intensive Care Unit to administering chemotherapy infusions throughout the hospital to serving as a Home Care nurse and manager, and now as Clinical Abstraction manager in Crozer-Keystone’s Quality Initiatives.
“I’ve never had a job that I didn’t love,” Birmingham says. “Over the years, I’ve cared for thousands of patients and their families, and if I made one minute of difference that improved their lives, that is my reward.”
In her current position, Birmingham continues to make a difference for patients by managing a department of 10 clinical abstractors who provide data that helps clinicians and evidence based medicine staff make decisions that will improve patient care. “Our team members are amazing,” she relates. “Their dedication and hard work makes it possible for us to make valuable contributions to the system’s EBM efforts. They perform miracles every day.”
Birmingham’s staff abstracts data for all EBM measures reported to Medicare and The Joint Commission, including acute myocardial infarction, stroke, pneumonia, heart failure, chest pain, pressure ulcer reduction, surgical care improvement, deep vein thrombosis, and hospital in patient-based psychiatric data.
“If our data helps our clinicians to provide concise, coordinated multidisciplinary care, we are bound to improve patient outcomes as well as reduce costs,” says Birmingham. “If, for example, the data supports care decisions that enable a patient to be discharged from the hospital in three days rather than five, that’s a positive outcome all the way around. The evidence shows that patients recover better in their own homes.”
Birmingham knows this firsthand. She has been on the other side of the bed as a patient numerous times, an experience which has given her important perspective and appreciation for nursing and the system’s efforts to improve patient care. “My experience as a patient in Crozer’s Cancer Center was amazing,” recalls Birmingham, who once worked in the Infusion Department in the hospital and was one of the first Crozer nurses to be certified in infusion therapy. “The nurses provided care that is the epitome of what nursing should be.” Currently, she is writing a book about her experiences, “The Other Side: A Nurse’s Journey Through Cancer.”
“As a nurse, you experience the joys and pain of life through your patients,” she says. Being a patient was a learning experience that has made my work even more meaningful. I came to understand the importance of embracing new ideas, asking questions every day, and doing all we can to improve patient outcomes in a whole new way.”
Caroline Haggerty, RN, has always wanted to know why she was using new protocols and practices to care for patients. “Nurses are constantly bombarded with changes and improvements to patient care,” she says. “It’s much easier to accept change and do things a new way when you understand the reason why.”
Haggerty’s inquisitive nature led her to evidence-based medicine and her current position as EBM program coordinator for Crozer-Keystone. She joined Delaware County Memorial Hospital in 1989 as a staff nurse and served for many years in the nursing pool, followed by several years in Home Care. Always committed to quality, Haggerty became involved with the Star Program for Quality Insights in home care. Ready for new challenges, she accepted her current position in 2005.
Currently, Haggerty is responsible for implementing improvement projects related to the Transformation of the Intensive Care Unit (TICU). These projects include ventilator-associated pneumonia (VAP), treatment of severe sepsis and septic shock and delirium. “Our first TICU initiative was the VAP bundle. We’ve been working on that for a while and we’re seeing rates of VAP decrease significantly system wide. The nursing staff is doing a phenomenal job,” she relates.
Haggerty notes that the system is beginning to have similar success with reducing sepsis mortality. “DCMH led the way, getting their program off the ground first, and they have seen a huge decrease in their sepsis mortality rate,” she says. “Sepsis initiatives at Crozer, Taylor and Springfield have experienced similar success.”
Haggerty is just beginning implementation and education for a new system-wide delirium protocol specific for the ICU patient.
“The implementation and education process can be a challenge,” she says. “We work very hard to get the word out to everyone, including those who work night shift and weekends. It’s very rewarding to see our efforts pay off in improvements in patient care and outcomes.”
She encourages all nurses to stay abreast of new developments in evidence-based medicine. “Read the literature and do research when you have a patient with an unfamiliar problem,” says Haggerty, who has just started an RN-to-BSN degree program at West Chester University. “I am constantly reading and surfing the Internet for the latest information.”
Linda Palma, RN, CEN, CNOR, is energized by her dual role as a perioperative nurse and an Evidence-Based Medicine program nurse at Delaware County Memorial Hospital. Since 2006, she has dedicated several days each week to EBM initiatives. “Standards are always changing and there’s always something new on the horizon with evidence based medicine,” she says. “I enjoy the challenge of keeping up with all the changes, educating physicians, nurses and staff about them, and serving as an information resource to everyone.”
In fulfilling both clinical and EBM roles, Palma is uniquely networked with physicians and nurses both at the bedside and as a resource. “Being at the bedside enhances your credibility regarding evidence based medicine, particularly with the physicians. They know that I understand and experience ever-changing medical practices from both sides,” she says.
A 30-year nursing veteran, Palma joined DCMH’s Emergency Department in 1982, a few years after receiving her nursing education at Gwynedd Mercy College. Since then, she has worked in all aspects of critical care as well as perioperative nursing, and served as project manager for the hospital’s new emergency department and intensive care unit. She also served in quality management for several years before moving into her current EBM role.
“Evidence-based medicine is very rewarding because it enables us to constantly improve patient care,” says Palma. “Over the past year and a half, the sepsis project has been particularly fulfilling. It has involved a lot of hard work, but we have truly made a difference for our patients with all the changes we’ve made in sepsis care.”
Currently, Palma is also part of a team working on a vaccine initiative for the OB population. After updating flu and pneumonia vaccine assessment forms and patient information to ensure that all CDC criteria are met, the team will begin implementation and education of the staff.
A member of the Association of Peri-Operating Room Nurses and the Emergency Nurses Association, Palma’s nursing philosophy is to “give it all you’ve got. I like good, aggressive management, using whatever is new to improve care and give patients the best care possible.”
Sharon Scott, BSN, MSN, has her finger on the pulse of a multitude of evidence based medicine measures at Crozer-Keystone Health System. As one of the system’s key resources for EBM information, she is responsible for the data integrity of reports going to Medicare, as well as tracking Medicare guideline changes and disseminating them to nurses, physicians and practice staffs to ensure timely compliance. Scott’s areas of responsibility include acute myocardial infarction (AMI), pneumonia, heart failure and pediatric asthma, as well as outpatient measures for AMI, chest pain and outpatient surgery.
“Evidence based medicine touches many different processes and specialties and most importantly, the quality of patient care,” says Scott. “We work to make sure that everyone is up to date and following the latest guidelines.” According to Scott, this is a significant challenge considering that Medicare guidelines are updated every six months and the manual has over 1,000 pages.
The volume of information sent from Crozer-Keystone to Medicare for each EBM measure is also considerable. “For outpatient surgeries, for example, we report the number of cases and whether an antibiotic was given within 60 minutes of cut time during surgery,” she explains. “We also monitor the type of antibiotic being used because Medicare guidelines specify certain antibiotic types according to the type of surgery. If the physician is not complying, we ask why and report that information. This is just one small example of the data we collect.”
Scott came to her role as an EBM program nurse with 30 years of nursing experience, all within Crozer-Keystone. At Crozer-Chester Medical Center, she served as an ICU nurse, nurse manager on medical/surgical and Telemetry units, night nursing supervisor, and outpatient congestive heart failure program manager. She also managed two research programs related to cholesterol, one federally funded. In her current role, she enjoys working across the system with all four hospitals. “This has given me a good view of the whole system and the ways that all of us are working hard to improve patient outcomes,” she says.
“It’s been rewarding to translate my experience into many different aspects of nursing work,” notes Scott, who received her bachelor’s and master’s degrees in nursing from Widener University. “It’s involved a lot of learning which has enabled me to continue to grow in my profession.”