A Message from the Chief Nursing Officer - Crozer-Keystone Health System - PA

A Message from the Chief Nursing Officer

It’s been more than six months since our Nursing Strategic Planning Retreat and a lot of hard work has gone into refining and launching system-wide tactics to address some key areas of concern. I am pleased to announce that several of these council-driven efforts are already reaping positive results.

In addition to the Home Care and Hospice Nurse Practice Council’s efforts to reduce re-hospitalizations – which are highlighted later in this newsletter – I would like to bring attention to the work of the Quality and Safety Council and Perioperative Nurse Practice Council.

Reducing Urinary Tract Infections (UTI)

A rise in the number of catheter-associated UTIs prompted the Quality and Safety Council to examine nursing practice in the care of the patient with a foley catheter and urine specimen collection. As it turns out, daily assessment and prompt removal of unnecessary catheters is key. Alternately, foleys that are necessary require a strict standard for care and specimen collection technique. This work led to revision of the “Use and Care of Foley Catheter” policy and the physician “Daily Foley Catheter Assessment/Order Set.”

The order set now provides an option where the physician may direct nursing to remove the foley once criteria is met based on nursing assessment. Physicians choosing this option need only complete the order set once. Physicians may choose to manage the foley removal themselves, which requires a daily reaffirmation/reorder. With the implementation of CPOE at Taylor, Springfield and Crozer, a team is working on building this into the electronic system. The new paper version will be implemented at DCMH.

As this work was being done, each infection Control committee took a deep dive into whether practice matched best practice at their site. Competencies and observations were done. The good news is that the CAUTI rate was zero for the last reported month at Crozer, DCMH and Springfield and continues to be a focus at all sites.

Changes to the “Urine Specimen Collection” policy have been completed but will not be rolled out until the Council has identified a cost- and time-efficient way to bundle necessary supplies for easy use. It anticipates this will be completed in the next two months.

Merging OR and Surgery Center Policies

In the operating rooms and surgery centers across the health system there are significant inconsistencies in the policies, procedures and forms being used. Late last year, the Perioperative Nurse Practice Council was given 18 months to merge these materials into a uniform set of documents – based upon best practices – that would be used across the system.

The OR record – which had never been popular among the nurses – was the first piece that the Council tackled. It was fully revised in two months.

Currently, the Council is working to revise the materials used in the PACUs, Short Procedure Units, Endoscopy Suites and by Interventional Radiology. It anticipates that these will roll out by June 2014.

Improved Communication

In the last newsletter, I emphasized the need for continued work in two key patient satisfaction measures – “communication about medication” and “communication with nurses.” In the second quarter of this fiscal year significant progress was made in both of these areas. This can be attributed to our nurses’ commitment to sitting down with the patient when explaining their care and always providing printed medication information in layman’s terms.

Computerized Provider Order Entry

CKHS has long been at the forefront of electronic order processing and has used it for everything but patient care. In October, we filled this gap with the launch of our computerized provider order entry (CPOE) system at Taylor. The primary advantage of CPOE is that it increases patient safety by reducing the likelihood of entry and interpretation errors. Other benefits of CPOE include its ability to reduce the likelihood of adverse medication events and screens that can be customized to enhance readability and ease of use. It’s expected that CPOE will go live across the health system by the end of January 2014.

DAISY Award Honoree

CKHS’ entrée into the DAISY (Dedicated, Autonomous, Innovative, Selfless and Extraordinary) Foundation provides us with a way to recognize our nurses for the valuable service that they provide. In October, Peggy Buckson, B.S.N., R.N., nurse case manager for CKHS Family Health, received our health system’s inaugural DAISY Award. In her role, Peggy provides education and coordinates care, outreach and transitions between inpatient and outpatient care for patients at high risk of hospitalization. Please join me in congratulating Peggy on this honor.

Looking Ahead to 2014

Our efforts to raise CKHS’ profile in the areas of quality and satisfaction continue into the New Year. The tactics outlined at our Nursing Strategic Planning Retreat will remain an area of intense focus as will our efforts to enhance our interaction with patients at the bedside.

I would like to thank each of you for your continued work and commitment to our patients and the health system. You are the heart of this organization and I am proud to be part of such a strong and dedicated team.

Best wishes for a safe and happy New Year.

Robert Haffey, M.B.A., M.S.N., R.N.
Chief Nursing Officer