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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Medication Assessment in the Older Adult: Using the Beer's List

Gretchen Zunkel
- Describe appropriate pharmacologic principles of medication use in older adults
- Review Beer's List Criteria (American Geriatric Society)
- Identify inappropriate and/or overlooked medication for the older adult
- Share with BH Unit staff, patients, families
Quality and Quantitiy of Patient Sleep in the Hospital: Perceptions and Measures

Karen Chalich RN

Inadequate sleep may result in physical and cognitive dysfunction. During hospitalization, interruptions from excessive noise, lights, and interruptions contribute to poor quality sleep. Patient and nurse reports of perception of sleep quality differ, with few studies comparing perception to measured quality and quantity of sleep. This non-experimental study compared patient and nurse perception, quality, and quantity of hospitalized medical patient's sleep.
Quality Leadership Academy: CAUTI Reduction Project

Melissa Fradette

Plan:

In the fiscal years of 2014 and 2015, 31 out of 66 (47%) catheter-associated urinary tract infections (CAUTIs) were acquired in patients with neurological diagnoses. This led to increased costs, decreased reimbursement, and hospital-acquired condition penalties. A thorough review of CAUTIs revealed 15 of the 31 (48%) were attributed to insertion practices; infections were acquired within 6 days of urinary catheter insertion. Eleven of the 15 (73%) were inserted in the operating room (OR).
Reduced Cost and Decreased Length of Stay Associated with Acute Ischemic Stroke Care Provided by Nurse Practitioners: A Single Primary Stroke Center Experience

Leah Roering NP, Michelle Peterson NP, Muhammad Shah Miran MD, Melissa Freese, Kenneth Shea MD, and M Fareed K. Suri MD

Nurse practitioner (NP) have a wider role in modern stroke centers providing quality evidence based care to patients with both in and outpatient settings for acute ischemic stroke (AIS) and transient ischemic attack (TIA) patients. We studies the outcome measures, length of stay (LOS) and cost before and after implementation of nurse practitioners as the primary medical provider in a community based stroke center.
Beacon Journey: Improving Patient Outcomes: Reducing Adverse Drug Events Using an Inter-Professional Team Approach

Laurie Annett, Nicole Higel-Backes, Jaclyn Hoppe, Michelle Huffman, Teresa Jahn, Bridget Klein, Jessica Mackedanz-Johnson, Kirsten Skillings, Jayna Theis, and Jessica Thoma

Literature states that the use of sedation regimens that include routine reversal of benzodiazepines or narcotic agents are not recommded. An inter-professional team concurred that planned reversals would no longer be the standard of practice for patients post post-procedural sedation. An inter-professional team analyzed the use of reversal agents, reviewed literature related to sedation and analgesia by non-anesthesiologists, and proposed recommendations for practice changes.
Protecting Patients from Hospital-Acquired Infections

Ann Backes

Goal: Implement chlorohexidine (CHG) bathing for patients on the Medical and Oncology Unit with a central venous catheter and/or urinary catheter in addition to existing prevention measures to reduce catheter associated urinary tract infections (CAUTIs) and central line associated bloodstream infections (CLABSIs), because increases in CAUTIs and CLABSIs were seen despite various unit and hospital prevention strategies in place.
Mindfulness Program at Work

Chelsie Bakken, Kathleen Mahon, and Kristi Patterson

Develop and implement a mindfulness based stress reduction program that is easily accessible, effective, and utilized by staff to improve care quality and positively affect the wellbeing of CCH employees.
SEP-1: Early Management Bundle, Severe Sepsis/Septic Shock

Roberta Basol and Jennifer Burris

To educate, monitor, and improve the sepsis core measure SEP-1 results required by CMS.
Moving Weekly Team Conference to Bedside

Joyce Belanger

CMS has specific requirements for all Inpatient Rehab Facilities. Weekly team conferences on the patients is one of the requirements. Team members required are Dr, LSW, PT, OT, SLP and RN. Our Practice Nurse (RN) attended conferences, as she has working knowledge of the patient. Our challenge was to get the bedside nurse, instead of the practice nurse, to attend the weekly conference.
Improving Transitions of Care for Newborns Requiring Home Phototherapy Through Innovation & Collaboration

Carla Bieniek and Kristi Patterson

Improve transitions of care for newborns requiring home phototherapy by providing skilled nursing services through Home Care and changing the phototherapy modality from the BiliBed to the BiliSoft which provides more intense home phototherapy & is easier to administer.
Heart Huddle: Increasing Cohesiveness in CCU and CVTU

Ashley Douvier

The American Association of Critical Care Nurses identifies six standards for a healthy work environment, two of which are skilled communication and true collaboration. CCU and CVTU are two separate units staffed by one Charge RN. A need to improve communication and collaboration has existed throughout both units. Thus, Heart Huddle has been developed. The objective of Heart Huddle is to bring cohesiveness to CCU and CVTU through improving communication and collaboration, which is imperative to a healthy work environment.
Reduction of Cesarean Section Surgical Site Infections (SSI): Progression and Implementation of Evidence Based Practice

Patricia Dumonceaux, Melissa Erickson, Kim Schuster, and Elizabeth Kiffmeyer

To improve cesarean section patient experience by reduction of postoperative SSI.
Inpatient Rehabilitation Performance Improvement: Skin Care and Guidelines

Golden Fisk

To improve skin integrity care as well as use of hospital policies and guidelines within Inpatient Rehabilitation.
Best Practice for Core Charge Nurse Orientation and Leadership Development

Melissa Fradette

Purpose Statement: Develop and implement evidence based, standardized orientation and leadership development for core charge nurses (CCN) compared to current unit-based orientation which has inconsistent content and structure.
ETC Code Stroke Improvement

Melissa Fradette and Jessica Miller

There was a 42% increase in median times for patients receiving alteplase (tPA) within 60 minutes from 48 minutes in Q3FY13 to 68 minutes in Q1FY15. Research indicates every 15 minute delay in stroke treatment, the odds of good outcome decreased by 10%. During two day rapid improvement event team members and content experts used process mapping to identify waste in current state ETC Code Stroke process and determine countermeasures to eliminate waste and improve throughout.
Finding the Missing Pieces: Comprehensive Cerebellar Assessments with Cytarabine Administration

Tara Hinnenkamp

A study conducted at the University of Maryland Greenebaum Cancer Center found that one in four nurses felt there were widespread inconsistencies with cerebellar assessments. One of every two nurses felt the current assessment was incomplete and the patient may be suffering as a result. Nurses need to have the means to accurately and consistently assess and document neurological changes noted with Cytarabine administration.
Improving Bedside ECG Monitoring in Telemetry

Teresa Jahn, Jennifer Lang, and Jaclyn Hoppe

To improve accuracy of bedside ECG (EASI lead) monitoring through accurate placement of electrodes and proper skin preparation.
Reducing Overnight Vital Signs

Jill Libbesmeier

As delirium has been identified to increase functional decline, cost per patient day of hospitalization, and length of stay, previous delirium work has been completed at St. Cloud Hospital. Changes in sleep pattern and sleep environment have been identified as a cause of delirium. The purpose of this project is to change frequency of vital signs on Med 1, Med 2, and Medical and Oncology, allowing for increased uninterrupted periods of sleep to help reduce delirium rates; in turn reducing average length and cost of stay.
National Database of Nursing Quality Indicators

May Schomer

National Database of Nursing Quality Indicators (NDNQI) was launched by American Nursing Association (ANA) in 1998, with an initial set of ten quality indicators that assessed the quality of patient care. The continued mission of the NDNQI's is to improve patient care and safety by providing evidence based national research to nurses by comparing nursing care data and the connection this data has on patient outcomes. A relationship between patient outcomes and nurse staffing practices was noted, but further data collection was needed to appraise the quality of nursing care on each hospital unit in order to assess, evaluate and improve patient care outcomes. Unit level of care measurements empowers the nursing units to enhance their quality of patient care. To improve the quality of patient care, evidence-based practices are researched, developed, trialed, and implemented where needed.
Optimal Perioperative Management of the Geriatric Patient

Sherry Sonsalla

Purpose: Review best practice guidelines, perform a gap analysis, and provide recommendations for areas of opportunity for geriatric surgical patients.
Integrative Therapy Program: Evaluation and implementation of aromatherapy in an inpatient setting

Wendy Wheeler

Purpose Statement: The purpose of this project is to implement integrative therapies, such as aromatherapy, in addition to current nursing interventions. Goal is to improve patient experience and outcomes and enhance the patient/nurse relationship.
Opening an Observation Unit

Emily Zempel

The definition, benefits, and structure of an observation unit within a hospital.
Utilizing a Protocol to Reduce Post-Operative Urinary Retention in Total Joint Arthroplasty

Gina Anderson-Malum and Naomi Schneider

Foley catheters have not routinely been used for our total joint patients for many years, leading staff to bladder scan and straight catheterize patients postoperatively. Bladder scanning and catheterization were identified as an inconsistent practice. Patients were commonly straight catheterized when nurses determind bladder scan volume and time of last void; yet the amounts for both and decision to catheterize were inconsistent. Also, the clinical evaluation and treatment was inconsistent among physicians. Variations in practice included rationale for a urology consult, use of medications for urinary retention, and documentation. Baseline urinary retention condition codes ranged from 8-18%, which led our team to choose urinary retention as a performance meansure in 2012 for The Joint Commission Disease Specific Care Certification. Objective: Describe the clinical and cultural impact the total joint urinary protocol has on decreasing urinary retention.
Inpatient Rehabilitation Unit Specific Orientation

Joyce Belanger and Becky Kastanek

CMS has specific requirements for all Inpatient Rehab Facilities. Data collection in the form of FIM "Functional Independence Measure" is one of them. Due to these requirements, it was felt that we needed to provide further education to our new hire staff from all disciplines.
Developing Cultural Competence

Patricia Blonigen-Heinen and Roberta Basol

Caring for patients from many cultures is an important part of health care today. Why learn about cultural competencies? Because developing cultural competencies benefits everyone. You can: help patients receive more effective care; help your facility meet standards of The Joint Commission; and improve your job performance.