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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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
Deep Tissue Injuries

Mary Pohlmann and Katie Meyer

Purpose Statement from Poster:
- Recognize and identify Deep Tissue Injuries
- Ability to describe and define Deep Tissue Injuries
- Increase awareness of Deep Tissue Injuries in order to promote early identification and treatment
Neuroscience Spine Float Buddy Program

Jenna Czech

Why?

In our commitment as a unit to role model best practice as we support the staff that float to us from other departments, we initiated a new process so all staff that come to our unit will feel welcome, well-prepared, and supported in their roles with our patient population, environment, and our team. It has been identified that we had opportunities related to resources for staff floating from other units.
St. Cloud Hospital Nursing Director Orientation and Mentorship Program

Deb Eisenstadt, Tiffany Omann-Bidinger, and Diane Pelant

Develop and implement an evidence-based orientation and mentorship program for nursing directors using AONE’s Nursing Executive Competencies along with a structure curriculum.
Journey to Zero NG-related HAPI's

Kristin Gaarder

From October 2015 to April 2016, there were five Stage II or higher inner nares hospital acquired pressure injuries (HAPIs) caused by nasogastric (NG) tubes, with one being unstageable. These occurred despite previously implemented evidence- based prevention strategies, which included:

• Two-person skin assessments on admission and return from surgery

• Two-person skin assessment upon transfer from unit to unit

• Daily skin assessments including under devices

• Access to the Wound Ostomy Continence (WOC) team
Magnetizing: Post Operative Nausea and Vomiting

Andrea Nyquist

Purpose:

To guide nursing care in the early recognition and treatment of PONV.

Prevalence:

Postoperative nausea and vomiting (PONV) is the most prevalent postoperative complication occuring within 24 hours of surgery.

Risk Factors:

Adults at a higher risk of PONV include:
- Female
- History of PONV, motion sickness and/or gastroparesis
- Postoperative opioid recipient
- Volatile anesthetic and/or nitrous oxide administration intraoperatively
- Pregnancy
- Use of birth control pills
Implications:

PONV can create a plethora of adverse events for the patient: anxiety and a sense of dread, increased risk for bleeding, dehydration and electrolyte imbalance, risk for aspiration and airway obstruction, vasovagal response, wound dehiscence, increased intracranial pressure, and increased cost with use of antiemetics and potential for prolonged length of stay.