Nursing Posters

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  Immunotherapy Serum Mixing: 2023 Best Practice Changes

  Eyas Abla MD, Paul Faybusovich DO, Matthew Lies, and Mallory Mondloch

  Background Story:

  CentraCare - Plaza Allergy & Asthma Clinic compounds immunotherapy serum with advanced training of licensed nurses. Effective November 1, 2023, USP (797) Pharmaceutical Compounding guidelines were updated and endorsed by the American Academy of Allergy, Asthma & Immunology (AAAI). The Allergy Clinic completed a gap analysis to determine what process needed to change to comply with these latest guidelines.

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  EYE CODE Protocol

  Christina Anderson MD, Maiya Dietz, Kelsey Bade, and Mallory Mondloch

  Purpose of EYE CODE:

  • Retinal artery occlusion (RAO) is a rare but detrimental adverse effect of cosmetic facial filler injections.
  • Requires prompt treatment and reversal to avoid patient blindness.
  • EYE CODE is a new protocol in place to avoid this complication.
  • Assist staff during a high stress event. •Improve patient safety & staff confidence. Way to receive continuing education credits through the clinic.

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  Implementation of a Two-Person Urinary Catheter Insertion Practice Change

  Brandy Berends, Elizabeth Kiffmeyer, Jenelle Overgaard, Amy Railson, and Morgan Thiry

  Decrease incidence of Catheter Associated Urinary Tract Infections (CAUTIs) for inpatients by implementing a two-person urinary catheter insertion practice change using a checklist.

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  You've Got to Move It, Move It!

  Jennifer Burris and Elizabeth Plante

  An increase in reportable hospital acquired pressure injuries (stage 3, 4, or unstageable) was found to be associated with patients refusing to participate in the prevention plan of care.

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  Progression of Care/Discharge Delay Panel

  Jennifer Burris, Jennifer Salzer, and LeAnn Volkers

  Plan:

  • To reduce the number of patients with a length of stay (LOS) greater than or equal to 26 days by 25% (from 199 to 150).
  • to reduce the average patient days for patients with a length of stay greater than or equal to 26 days by 25% (from 39.7 to 30).

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  Gamification: Integrating into the Perioperative Environment

  Tammy Filippi, Nicole Helgeson, Jennifer Salzer, and Courtney Van Vickle

  What is Gamification?

  • Using game attributes in a non-game context.
  • Including game elements such as points, prizes, leaderboards, etc.
  • Goal is education rather than entertainment.

  Why Gamification?

  • Increase staff engagement.
  • Optimizes the learners' outcomes.
  • Research has shown no negative outcomes.
  • Improved learning behaviors and attitudes towards learning.

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  Barriers to Implementation of Practice Guidelines against Fluid Restriction in Heart Failure

  Mary Geisenhof

  The overall goal was to support best practice around fluid restriction in care of the patient with heart failure.

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  Code Blue Debriefing

  Micaela Herbst-Bialke

  Situation and Assessment:

  Opportunities to improve code blue events have been identified by comments received on code blue critiques and results from a survey completed by 120 code blue team members.

  Background:

  As referenced by the American Heart Association along with Get with the Guidelines, post code debriefing is a key element to promote continuous quality improvement in patient care. Post-event debriefings are a foundational behavior of high performing teams in improving individual and team performance.

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  Healthy Eating & Shift Work

  Lisa Kilgard

  To provide knowledge and education to individuals who engage in shift work. Which may assist them in maintaining a healthier eating and lifestyle.

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  What's the Plan? Give me the Patient's Story

  Holly Kockler and Amber Guzman

  Plan:

  The aim for this project was to improve staff satisfaction with care planning and bring the patient's plan of care to the forefront for all staff.

  Key Drivers:

  • Care Plan notes were difficult for care team to understand how the patient was progressing towards their goals.
  • Care Plan lacked the ability to tell the patient's story and represent the interdisciplinary plan of care.

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  Technology Decreases Treatment Decision Times

  Angela Moscho

  Patients who experience a stroke while hospitalized have a higher mortality rate than those who present to the emergency department. Our plan is to utilize technology to allow the stroke provider to evaluate the patient while in their hospital room, instead of waiting until the patient is in the CT scanner. Utilizing technology of an iPad for inpatient code strokes will allow for quicker assessment of the patient, resulting in faster treatment decision for this population.

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  Creating a Centralized Immunization Resource Center

  Teresa Nathan

  To support clinic nurses in their knowledge & comfortability around immunizations, an Immunization Resource Center was created on SharePoint. Having resources and educational materials located in a single location can help ensure consistency across the clinic system in our work with immunizations.

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  Enhancing Patient Care: The Power of the Endoscopy Checklist

  Emily Obermiller

  Endoscopy procedures start at 8:00 a.m., but inpatients are often unprepared when report is required at 7:00 a.m. This lack of patient readiness causes delays in endoscopy start times, creates safety concerns, and delays in care. Nurses who are well-informed about procedural preparation are more likely to have patients properly prepared, improve safety, and increase effective communication.

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  Research Makes a Difference: Changing Post Surgical Vital Signs

  Elizabeth Plante, Sadie Seezs, Jennifer Burris, and Tiffany Omann-Bidinger

  Research Question:

  Are reduced frequency of vital signs as effective in identifying patient deterioration in postoperative adult orthopedic and spine patients after a post anesthesia care unit stay with transfer to orthopedic and neuroscience spine units when compared to current practice?

  Conclusions/Implications:

  • Changing the frequency of post operative vital signs provides the same quality, not directly affecting an increased risk of death.
  • Reduction in number of times vital signs needed completion, saving time for nurses to complete other duties.
  • System wide change to routine post operative vital signs for floor level patients was implemented.
  • Recommend future research for obstetric and pediatric patient population

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  Strategic Use of Storytelling as an Advocacy Skill for Social Justice in Nursing Practice

  Theresa Reichert

  The purpose of this practice project is to cultivate storytelling as a nursing skillset, preparing nurses as social justice advocates within nursing practice.

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  Sticks and Stones May Break My Bones, But Words Can Hurt Me Too: Psychological Safety and Microaggressions

  Theresa Reichert, Janelle Maciej, and Julia Vang

  To foster a healthy work environment, address reports of microaggressions, and improve psychosocial safety within the SCH Telemetry team

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  Standardized Orientation in a Multi-Site Clinic System

  Cathrine Robak

  There are over 50 clinics serving more than 8 counties in CentraCare. Managers and supervisors at each clinic lead orientation of new nursing employees. The ambulatory educator recognized a need for standard orientation tools and resources as clinic managers and supervisors shared that they were each completing orientation of new nursing employees in a different way.

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  Professional Development in Practice: Enhancing the NPD Role

  Amy Stang

  Inquiry:

  The problem this project is addressing is a lack of knowledge related to NPD scope and standards in the organization. The education department is largely decentralized, with staff reporting to various leaders outside of NPD department. Some areas within the organization lack support and continuing education specific to NPD.

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  ICU CAUTI Incidence Reduction

  Michelle Gamble

  Situation:

  Catheter-Associated Urinary Tract Infection (CAUTI) rates in the adult Intensive Care Unit (ICU) increased from nine infections in FY21 to 18 in FY22.

  Backgroud:

  CAUTIs are the most reported healthcare acquired infection. It is important for healthcare providers to understand the complications and effects of CAUTIs. CAUTIs contribute to extended length of stay, increased healthcare costs, and patient morbidity and mortality.

  Most CAUTIs are directly related to inadequate urinary catheter care. Evidence based practice demonstrates a decrease in CAUTIs related to the use of Theraworx^® Protect wipes twice daily (BID) and as needed (PRN) for patients with a urinary catheter.

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  Safe Intra-Hospital Transport of Adult Patients on Non-Critical care Units

  Teresa Jahn, Janelle Maciej, and Greta Titus

  Plan:

  Between 2021 and 2022, two non-critical adult patients returning from the imaging department after an invasive procedure developed increased oxygen needs, which ended in death for on patient and a transfer to critical care for the other.

  No formal guidelines exist for the intra-hospital transport by unlicensed personnel may be absent. An intra-hospital transport checklist was developed for non-critical care patients leaving the unit for procedures in the imaging department.

  Do:

  • A "RN Pre-Invasive Procedure Transport Safety Checklist" was created by a telemetry RN (MSN student, Greta Titus) and CNS, Teresa Jahn
  • The checklist was designed to answer questions to determine a patient's hemodynamic and respiratory stability prior to transport by an unlicensed person
  • The checklist is to be completed prior to transport on all patients leaving the unit for a procedure in the imaging department (i.e. paracentesis, thoracentesis, biopsy, etc.)
  • If one of the questions answered is "yes", the next step is to prompt a huddle with Resource RN or Charge RN to identify f a patient is safe for transport without a RN.
  • The "why" for the change was presented by Greta Titus during the November 2022 CentraCare Heart and Vascular Center Clinical (CCHVC) Practice meeting
  • Staff were also notified of this change during Telemetry daily huddles and weekly updates
  • The trial started on Telemetry beginning 11/1/2022
  • Follow up on the progress of the practice change was presented by CCHVC CNS during Telemetry Education Days in January-February 2023

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  Clinical Nurse Specialists: A Rare Breed

  Teresa Jahn, Evalyn Michira, and Elizabeth Plante

  What is a CNS?:

  • A clinical nurse specialist (CNS) is an advanced practice registered nurse (APRN) with graduate level education in nursing.
  • CNSs are prepared to provided leadership, consultation, and clinical expertise for patients and their families, nurses, and systems.
  • Have the autonomy to diagnose and treat based on advanced clinical assessment like other APRNs (Nurse practitioners, certified nurse midwives, certified registered nurse anesthetists).
  • CNS work in all areas of healthcare like clinics, emergency departments, hospital units, entire healthcare systems, or even as independent practitioners/contractors.

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  Recognition of Nonconclusive Seizures in Patients After Cardiac Arrest Using

  Teresa Jahn and Elizabeth Plante

  Background:

  Evidence - Prevalence of nonconvulsive status epilepticus or other epileptiform activity in patients who are comatose after a cardiac arrest is between 12-22%. Consistent with the literature, at this facility approximately 12% were found to have non convulsive seizures. Prolonged epileptiform discharges may cause secondary brain injury and increased mortality. In 2020, the American Heart Association recommended EEG monitoring should be promptly performed and interpreted for the diagnosis of seizures in all comatose patients following cardiac arrest.

  Local Problem - Comatose patients admitted to critical care after cardiac arrest who require targeted temperature management (TTM) have continuous EEG monitoring ordered STAT. Neurodiagnostic technologists who apply EEG monitoring are not available 24/7.

  Conclusions/Implications:

  • While the rapid EEG recording may have limitations compared to continuous recordings for diagnostic purposes, it has immediate feedback for monitoring of nonconvulsive status epilepticus.
  • Continuous EEG monitoring can take 45 minutes to set up and much longer to obtain diagnosis of status epilepticus.
  • Continuous EEGs have broader diagnostic capabilities, however, are not monitored continuously by neurology providers, which could delay the identification of seizure activity.

  Recommendations:

  • Continue immediate placement of rapid EEG if technologists are not available within one hour.
  • Continue to replace rapid EEG with continuous EEG when technologist becomes available.
  • Explore improved capabilities for more timely reading and diagnosis of continuous EEG.

  
  

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  Sterile Tubing Changes to Prevent CLABSIs in the NICU

  Rachel Janson and Megan Meyer

  Purpose Statement:

  NICU patients have a decreased risk of CLABSI infections when two-person sterile central line changes are implemented into central line maintenance bundles compared to bundles that only use one-person clean line change techniques.

  Background:

  Neonates admitted to the neonatal care intensive care unit (NICU) often require the placement of central lines for the administration of medications, fluids, parental nutrition, and hemodynamic monitoring. Despite their many advantages, central lines can lead to serious infections, known as cental line associated bloodstream infections (CLABSI). These infections are not related to an infection from another site and develop within forty-eight hours of removal. CLABSIs are a major contributor to morbidity and mortality in the NICU population and are costly to hospital systems. According to Mobley & Bizzarro, infants who develop CLABSIs can cost up to an additional $50,000 and add as many as ten days to their hospital stay when compared to other infants without CLABSIs (2017). An evidence-based approach that has shown to improve patient outcomes and reduce CLABSIs is the use of a bundle, which is utilized upon insertion and during maintenance of the central line. Based on the available research, the most common CLASBI bundle elements include: using maximum standard barrier precautions, using a specific skin preparation & line dressing protocol, daily central line need assessments, a two-person line change technique, specific education and training for staff, and quarterly audits (Payne et al., 2018). The St. Cloud Hospital NICU currently utilizes these practices expect for a two-person line change with sterile technique.

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  Transitions to Normal Saline ONLY for CVADs

  Megan Lehn and Ann Backes

  Purpose Statement:

  The purpose of this project is to implement a practice change throughout the system to remove heparin flushes for Central Venous Access Devices (CVADS) pending a successful pilot on Medical Oncology.

  Synthesis of Evidence:

  • Shama et al (2019) conducted a systematic review and meta-analysis including 886 participants that revealed no clear differences in CVC patency between heparin and NS.
  • Klein et al (2018) conducted a pilot study on a 30-patient bone marrow transplant unit, each patient had a new CVC and were divided into two groups. Among 698 catheter-associated events overall incidence of central line issues were similar in both heparin and normal saline group.
  • Egnatios & Gloria (2021) studies 37 patients receiving clinical trial infusions, they divided the study into two phases. During heparin phase there were 302 port accesses and four alteplase orders, during the NS study there was 261 accesses and seven alteplases orders. Alteplase was successful every time it was used.
  • Zhong et al (2017) performed systematic [sic] review on use of heparin v. flushing protocols. Ten randomized control trials involving 7,785 participants were included in the meta-analysis. No general differences found between heparin v. NS in maintaining patency.
  • Goossens et al (2013) oncology patients were randomly selected from 2009-2011. 382 were ultimately selected for normal saline group, and 283 for heparin group. All nurses were trained in proper pulsatile technique before study, it was found intimately heparin was not superior in comparison to NS in maintaining the patency of CVC.

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  Promotion of National Certification in Telemetry

  Janelle Maciej

  Situation:

  Goal to bring awareness to telemetry nurses, the specialty certifications they are eligible for, and criteria for eligibility. Currently, six telemetry nurses hold a nationally recognized certification.

  Action Plan:

  • March 19, 2023 was Certified Nurses Day and was the kickoff for the start of encouragement for telemetry nurses to be certified.
  • Each telemetry nurse was delivered a card and lifesaver candy inviting them to consider a nationally recognized certification.
  • A certification informational packet promoting CV-BC and PCCN certification was placed at each desk and referenced during huddle for one week.
  • Certification preparation books are available upon request.