Nursing Posters

Nurses at CentraCare Health are engaged in finding ways to improve all aspects of practice of nursing in the clinical setting. The following are posters created in the process of Evidence-based Practice Projects and clinical improvement.

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Promoting Patient Outcomes: CLABSI Prevention

Woon Paek

What is a CLABSI?

“A central line-associated bloodstream infection (CLABSI) is a serious infection that occurs when germs (usually bacteria or viruses) enter the bloodstream through the central line” (CDC, 2021)

Best practices for preventing CLABSIs:
- Perform hand hygiene
- Don proper PPE
- Sterile/aseptic technique during insertion
- Prioritize for cares related to central line first
- Daily assessment for need of central line
- Daily chlorhexidine gluconate bathing
- Remove catheters that are unnecessary
- "Scrub the hub" BEFORE EVERY access
- Change dressings every 7 days or as needed
- Assessment of site/dressing condition
- Change purple Ultrasite caps with dressings
- Tubing changes per CentraCare policy
- Discard piggyback tubing after disconnection
- Patient education regarding central line
- Staff education and audits
Open All Hours!: Bariatric Surgery Patients Love CSC

Naomi Schneider and Mallory Mondloch

During the fall and winter of 2020, St. Cloud Hospital saw a dramatic increase in the number of COVID-19 patients. Additionally, elective surgeries in Minnesota were on hold during the early months of the pandemic, and later in 2020 there was a significant backlog of these patients, waiting for their procedure. To serve patients and their families, St. Cloud Hospital teams planned for a way to safely and professionally offer surgical care needs to Central Minnesota.
ICU Liberation: Early Mobility and Exercise

LeAnn Volkers, Holly Kockler, and Kristi Patterson

The aim of this project was to streamline and standardize the delivery of the follow up Important Message from Medicare (IMM) for IP admissions across CC and Carris-RWF in compliance with regulatory standards of care.

Key drivers identified:
- Site specific variation
- Underutilization of Epic functionality
- Use of data to understand performance
Preoperative Weight Loss for Patients Undergoing Lumbar Spine Surgery Utilizing Motivational Interviewing to Decrease Postoperative Complications: A Quality Improvement Project

Amanda Welle

Do patients who are obese, based on BMI>30 and are offered lumbar spine surgery, who undergo preoperative MI via telehealth to lose weight, compared to those who don’t undergo MI have decreased postoperative complications at 30 days postoperatively?

Conclusions/Implications:
- Results from this QI project suggest a higher BMI class is associated with postoperative complications-wound infection.
- However, given the small sample size no conclusions could be drawn
- This QI project should be replicated on a larger scale
- The process for recruitment and intervention is established. The Neurosurgical providers are supportive of the continued study.
Increasing Access to Data through Microsoft's Power BI

Rumana Ahmad and Kristi Patterson

What is Power BI?
- A collection of software services, apps, and connectors that work together to turn unrelated sources of data into coherent, visually immersive, and interactive insights.
What’s in it for me?
- Users can quickly & easily explore trends for CC inpatients across common outcome measures including case counts, length of stay, mortality, & unplanned readmissions to help identify variation & opportunity for improvement. For example, compare COPD patient case counts, length of stay,and in-house mortality across CC hospitals.
No One Goes Missing: Creating an Elopement Risk Safe Plan of Care

Jennifer Burris, Kathryn Collins, Holly Kockler, Tiffany Omann-Bidinger, and Elizabeth Plante

To identify patients at risk for elopement by developing an evidence-based elopement risk screening tool and plan of care.
Admission Documentation Overhaul

Jennifer Burris, Holly Kockler, and Hillary Waldum

Improve the admission documentation workflow by revamping the admission Navigator and Functional Health Assessment
Implementation and Standardization of Evidence Based Practice for Reprocessing of Flexible Endoscopes

Patricia Dumonceaux, Jenna Rooda, and Dena Walz

To improve patient safety and quality of care by implementing a standardized process for high level disinfection (HLD) of flexible endoscopes
A New Approach to Sternal Precautions: Keep Your Move in the Tube

Kelijo Fernholz, Jayna Theis, and Erik Anderson

Purpose:
- To guide patients and staff in a new approach to sternal precautions following median sternotomy
Current Practice:
- 10-pound lifting restriction for 4 weeks
- 20-pound lifting restriction until 3 months post operation
- Limited arm exercises
- Sit to stand push restrictions
Why Change:
- Literature review demonstrates great variation in sternal precautions
- Currently too restrictive; may hinder recovery and long-term mobility. Too many restrictions can create fear of movement, resulting in short term rehab discharge needs
- To create more independence for the patient, less reliant on family members for ADLs and basic needs. Patients to return to regular home and work activities sooner
- To decrease sternal wound complications
Contemporary Treatment Options for Pulmonary Embolism

Tanya Glenz and Teresa Jahn

Purpose:

Provide RNs education on the classifications of PEs and new catheter directed treatment options.

Significance:
- PE remains a common and lethal entity
- PE is the 3rd leading cause of cardiovascular death in hospitalized patients (60,000-1000,000 per year)
- 150,000-250,000 PE related hospitalizations per year
- RNs must be knowledgeable of the classifications of PEs and catheter directed therapies to promote positive patient outcomes
- Prior to catheter directed therapies, submassive PEs had a mortality rate up to 20% at 3 months and were traditionally treated with IV heparin, or oral anticoagulant therapy
High Reliability Principles in Safety

Abby Henderson and Leigh Klaverkamp
- Subject matter experts compare actual performance to expected performance.
- A standard set of questions for specific subtypes of events help establish trends.
- HRO's (High Reliability Organization) equip leaders and frontline staff to spot systemic causes of human error.
Routine Post Surgical Vital Signs: Time for a Change

Kristina Kjellberg, Elizabeth Plante, and Sadie Seezs

Purpose Statement:

The purpose of this evidence-based practice project is to evaluate the current routine post operative vital signs and determine if reduced frequency of vital signs is as effective in identifying deterioration after a post anesthesia care unit (PACU) discharge.

Synthesis of Evidence:
- Patient survival in the post operative time period is maximized with the recognition and management of abnormal vital signs
- Post op periods can carry great respiratory and circulatory complications, which are identified by abnormal vital signs especially heart rate and blood pressure
- Multiple sources have identified that current frequency of post operative vital signs is based on traditional rather than literature
- There are minimal resources identifying any standards of practice for post surgical vital sign monitoring after a patient leaves the PACU
Suspension of Independent Double-Check for SubQ Insulin Administration

Mallory Mondloch and Jennifer Watson

Study:

After a 1-month pilot of suspending the dual sign-off/independent double-check process, 160/163 random subQ insulin administrations from various units were administered correctly. This yielded a 98% success rate. No patient harm occured.

Plan:

Per Institute of Safe Medication Practices, dual sign-offs/independent double-checks are more effective for select high risk meds and not all. Since implementation of the insulin calculator, medication errors related to subQ insulin administration have reduced compared to previously when solely two licensed staff members performed a manual, independent double-check. After implementation of the validated eMAR tool - the insulin calculator - it was still required for two licensed staff members to perform independent double-checks. Due to caring for COVID patients in isolation, nurses observed workaround practices with great variation related to subQ insulin administration and documentation because of this independent double-check requirement. Nurses raised concern for patient safety and workflow efficiencies. A literature review was conducted which revealed support for utilization of the insulin calculator without the need for the additional manual independent double-check/dual sign-off in Epic.
Improving Hepatitis B Vaccination Rates in Nephrology Patients with Chronic Kidney Disease: A QI Initiative

Jill Swanson
- Hepatitis B vaccination is an important health maintenance preventative measure for patients with chronic kidney disease (CKD)
- Prior to initiating dialysis, hepatitis B vaccination administration is proven to be more effective than waiting until patients begin dialysis treatments.
- Efficacy and immune response of the hepatitis B vaccine is greater when kidney function is greater
- To better improve hepatitis B vaccine administration among the CKD stage 4 population, education measures and Epic modifiers will be implemented to achieve change
- Nursing knowledge and hepatitis B vaccine administration will improve after implementation of these measures
Rapid Evaluation Teams (RET): No Longer Just for Hospitals

Amanda Thorson

Study:

Everyone goes to the Nursing Home for End of Life - Right? Wrong Cumulatively, over a 4-year study there were 678 residents with Full Code status residing at Carris Health Care Center and 687 residents the DNR/DNI status. That is only a 10-resident different between Full Code and DNR/DNI

Plan:
- Improve long-term care staff's ability to call for, and receive, support to rapidly evaluate and address an urgent or concerning situation.
- Need for this plan is supported by increased number of OHFC substantiated events related to code status in MN and number of residents with Full Code status in long term care facilities.
- Barriers to Change: amount of education needed to increase number of CPR certified staff and to train on RET process, establishing one true source for code status for residents, establishing facility equipment needs for crash cart.
A Practice Innovation to Improve Staff Vaccination Knowledge and Skills

Ijeoma Ugochukwu

Abstract:

The practice improvement project explored the best practices for equipping CentraCare Health System's (CCHS) Licensed Practical Nurses (LPNs) and Certified Medical Assistants' (CMAs) with childhood vaccination knowledge and communication skills necessary to educate hesitant patients and parents about the benefits of vaccination compliance. Innovative computer-based education (CBE) was identified and developed to empower LPNs and CMAs working in the ambulatory setting with childhood vaccination knowledge and communication skills to improve their ability to educate hesitant patients and parents about the benefits of vaccination. The CBE module was guided by the Theory of Planned Behavior in identifying vaccination knowledge and communication intention. Intentions to use acquired vaccination knowledge and communication skills were assess pre and post the CBE.

Results:

The results are statistically significant indications that both new and existing LPNs and CMAs gained the necessary vaccination knowledge and communication skills to be advocates of vaccination compliance. Post CBE mean scores on vaccination knowledge and communication skills were statistically higher in both new and existing employees (all p< 0.0005). Self-reported intentions to use vaccination knowledge, initiate vaccination conversations, and utilize the vaccination communication skills post CBE were high. Continuation of the CBE vaccination education may increase vaccination compliance rates and avert potential outbreak of communicable diseases. Further studies should explore LPNs and CMAs experiences with hesitant patients at the point-of-care.
Performance Improvement Leadership Rounding Implementation

Dena Walz

To improve patient experience scores and address patient concerns in real time.

A proactive behavior that facilitates leaders building relationships with patients and families, managing expectations, and achieving and validating consistency of key behaviors.

A member of leadership will conduct a purposeful conversation with a chosen patient three days a week regarding the care provided during their procedural appointment.
Providing Education Regarding Antimicrobial Stewardship for the Bedside Nurse

Anna Boeke
- Two million people acquire drug resistant bacteria and around 23,000 die from infection-related resistance each year (CDC, 2018a) and Up to 50% of antibiotics are incorrectly prescribed, including usage, dosage, and duration (CDC, 2017)
- Clostridium difficile (C.diff) is a common problem seen in the hospital
- Antimicrobial stewardship (AMS) as a proven method of addressing the problem of antibiotic resistance by education, multidisciplinary efforts, and refined resource utilization
- The biggest problem is nursing staff are unsure how to participate in AMS!
Preventing CRBSI'S in Hemodialysis

Kristen Dombovy

The aim of this project was reducing CRBSI’s below the predicted number of bloodstream infections with the implementation of the ClearGuard® chlorhexidine-based antimicrobial disinfecting cap.
St. Cloud Hospital Hand Hygiene Achievers

Patricia Dumonceaux, Sara Maciej, Jessica Reed, and Tamara Welle

Develop and adopt a culture change to increase hand hygiene compliance across all St. Cloud Hospital (SCH) inpatient and outpatient departments
- Hand hygiene is the best method to prevent the spread of infection (CDC, 2017).
- Historical data for SCH indicated below desired goal of 95% compliance with hand hygiene practices and continued identification of hospital associated infections.
- Employee engagement best achieved through promoting culture of safety supporting hand hygiene best practices (Piras et al., 2018).
- Educating staff on the WHO 5 Moments of Hand Hygiene, developing monitoring process for assessing opportunities to complete moments of hand hygiene, and providing detailed feedback can enhance results and improve culture (Haas, 2014).
- All staff survey identified best sources of performance feedback comes from peers and direct leadership.
Reduced Frequency Monitoring Post-Stoke Treatment

Melissa Freese

In 2020, the nation was faced with a pandemic that quickly depleted health care resources. Standards of care were reviewed to identify opportunities to reduce the burden on healthcare resources. One of the standards of care that was reviewed nationally and locally at the St. Cloud Hospital (SCH), was the postalteplase/ thrombectomy patient placement and monitoring.

The standard of care for the placement and monitoring of post-alteplase patients was established during the 1996 NINDS trial and has not been studied since. Very minimal literature is available on the standard of care for patient placement and monitoring post-thrombectomy.
Implementation of Proper Lead Selection Based on ECG Practice Standards in Hospitalized Patients

Teresa Jahn, Nicole Hubbard, Samantha Pohlmann, Lauren Hoeschen, and Shayna Lahr

Ensure adult patients in a 36 bed Telemetry Unit and 14 bed Cardiac Intensive Care Unit (CICU) with the diagnosis of STEMI and NSTEMI are being monitored in the appropriate leads to detect acute or silent ischemia and arrhythmias.
Huddle to Enhance Patient Progression of Care

Melinda Jennings, Kristi Patterson, and Jennifer Salzer

CentraCare (CC) is committed to improving patient flow and is now using the Geometric Mean Length of Stay (GMLOS) Index as our primary measure of success. This is a Key Performance Indicator that is monitored by the Patient Flow Steering Committee and Executive Leadership. In recent years, SCH GMLOS Index is higher than expected.
Implementation of a Chemotherapy Guideline: A Quality Improvement Project to Standardize the Chemotherapy Delivery Process

Sara Maciej

Adjusting chemotherapy rates is one gap in chemotherapy practice that evokes inconsistency. The purpose of this project was to implement a standardized guideline for staff to utilize in adjusting rates of chemotherapy medications.
Meeting the Educational Needs of the Busy Bedside Nurse: Curbside Education an Innovative Program

Ashley O'Connell, Kayla Waldoch, and Amy Junes
- Seek out educational needs of staff based on current changes, trends and new hires
- Provide on the spot reinforcement of skills, policies, education and policy changes for all staff
- Implement skill stations, including "off shifts", to increase staff cohesiveness and preparedness in emergent and nonemergent scenarios