Memorial Medical Center
New Knowledge, Innovations and Improvements
Rapid Clinical Exam | Star 45
2 The number of innovations our
Emergency Department has initiated
to speed patient care.
In 2012, MMC’s
ED implemented the Rapid Clinical Exam
process, an evidence-based process
for expediting the care for Emergency
Department patients that has been
adopted by many leading healthcare
organizations across the country. The
Rapid Clinical Exam is designed to “make
things happen fast” for ED patients,
according to Jennifer Davis, RN, BSN,
ED nurse manager. Upon presentation
to the ED, each patient is seen by the
Triage Lead Nurse, who determines the
chief complaint. Emergent patients are
sent to the treatment area immediately,
and others are sent to one of three ED
physician/nurse teams, where they are
triaged and assessed. Diagnostics can be
ordered and completed in this area, with
patients waiting for results in the waiting
area. This facilitates patient throughput
by assuring rapid assessment and timely
treatment.
The Star 45 program was also
implemented in the ED during 2012 and
is based on meeting the needs of patients
presenting with stroke symptoms by
getting them to the interventionist rapidly.
The ED nurse sees the patient first and
identifies signs of stroke, then has the
ED physician examine the patient. A
Stroke Page goes to Laboratory, Medical
Imaging, the stroke resident, the
attending physician, the interventionist,
and Anesthesia. Then the nurse
completes a full assessment, initiates IV
access, and gets lab specimens drawn
and an EKG completed. The nurse
accompanies the patient to a CT scan
within 20 minutes of admission. All results
are assimilated for the interventionist in
less than 45 minutes from admission.
The timeliness of the steps increases the
likelihood of optimal long-term outcomes
for patients experiencing a stroke.
Glycemic Control Work Group
30% The improvement in time between glucose
reading and administration of insulin prior to
meals due to a significant improvement in the tray delivery
process for patients on insulin regimens.
Jennifer Bond, RN,
MSN, nursing outcomes improvement facilitator, and the Glycemic
Control Work Group spearheaded this new process for delivery of
consistent carbohydrate meals for patients needing glycemic control.
The room service associate reports delivery of the patient’s tray to the
unit secretary, who calls the patient’s nurse. The nurse alerts the
appropriate nursing tech, who completes testing the patient’s blood
glucose and reports the results to the nurse. The nurse then prepares
the appropriate amount of insulin and administers it to the patient in
the appropriate time frame.
The new process facilitates a decrease in
hyperglycemia events and less variation in the patient’s blood glucose
levels. In addition to improved patient outcomes, nursing
satisfaction has also improved because the process enables nurses
to better meet patients’ care needs. This initiative enabled us to meet
our 2012 housewide goal of at least 78 percent of patient days with
blood glucose between 70 and 180 mg/dL.
Surgical Interventions on Hip Fractures
92% The decrease in readmission
rate for patients who had surgery
for hip fracture.
Jennifer Perkins,
RN, BSHA, program coordinator for
Orthopedic Services, led a Six Sigma
Green Belt project focused on improving the timeliness of surgical
interventions for patients presenting to MMC with a hip fracture.
She and her team (Jennifer Neff, RN, BSN, 4B nurse manager, and
representatives from the orthopedic surgeons and hospitalists)
reviewed the literature and identified that hip fracture surgery is
associated with fewer readmissions and complications if surgery is
performed within 48 hours of admission to the first healthcare facility.
This applies to patients who are directly admitted to Memorial
following their injury and to those transferred from another facility.
The expectation to operate within 48 hours after admission was
communicated to Emergency Department staff and physicians,
orthopedic surgeons, cardiologists, anesthesiologists, hospitalists
and nursing staff in ED, Surgery and 4B Orthopedics. ED staff and
physicians expedited acquiring hospitalist consults to enable early
surgical clearance for these often elderly and medically complex
patients. Surgery staff added hip fracture cases to the surgery
schedule promptly upon notification of need. Patient care facilitators
on 4B fulfilled a critical role by reaching out to surgeons to arrange
cases and get medical clearance.
These interventions also resulted in
a 44 percent decrease in postoperative complications, and a decrease
in time from injury to surgery by 22 percent.
Active Research Protocols
10 The number of active research protocols being led by Memorial nurses.
Evaluating Graduate Nurse Transition with Ramping – Yvonne Pellerin, RN, MSN, 2E Oncology Nurse Manager
- This study evaluated the impact of a process to gradually increase new graduate nurses’ patient care
assignments following standard orientation. Results demonstrated a positive impact on the ability of
new graduate nurses to successfully achieve role independence by incrementally adding to their patient
assignments based on ongoing performance reviews and self-assessment. This study has been presented
at a national nursing conference.
Identifying Variables Predictive of Emergency Events after Post Anesthesia Care Unit Discharge –
Deidra Glisson, RN, MSN, MBA, Director, Nursing Operations; Kristyn Yocius, RN, BSN, 2G;
Geri Kirkbride, RN, PhD, (c), Nursing Research Facilitator
- This case-control study is looking at variables predictive of clinical deterioration in patients following PACU
discharge. Patients who require emergency interventions within 24 hours of discharge from PACU are
being compared to similar patients who did not require such interventions. The goal of this work is to
develop a screening tool to determine appropriate inpatient unit placement for surgical patients. This work
is supported by a grant from the Memorial Medical Center Foundation.
Preferences for Personal Hygiene for People of Size –
Mary Dial, RN, BSN, 2B; Jennifer Holmes, RN, MSN, 3G Nurse Manager; Cecilia Wendler, PhD, RN
- The goal of this study is to learn about hygienic care preferences and practices for these patients at home
in order to better meet their needs when they are hospitalized. The study will enable MMC nurses to
implement care processes to address the unique infection, skin impairment, and immobility risks common
among this population. This work is supported by a grant from the Memorial Medical Center Foundation.
Nursing Informatics Innovations
3 The number of Nursing Informatics innovations implemented in 2012.
Among them was
CareAware, an electronic interface between cardiac monitors and the ClinDoc flowsheet in the
critical care units. The staff nurse triggers the interface by clicking on the desired documentation
time in the flowsheet. When the information flows across, the nurse reviews and verifies it, clicks
on the signature checkmark, and documentation is complete. This reduces nurse time and
potential documentation errors, and frees the nurse to attend to the patient.
Family Maternity Suites (FMS)
went live with several components of electronic nurse documentation, which completes the roll-out of nursing
documentation across the nursing units. The labor and delivery documentation remains on paper, but all
postpartum and nursery information is documented electronically. Our Informatics colleagues built the Infant
ClinPic with neonate-specific information including mom’s and baby’s blood type. Infant weight is visualized
in grams and in pounds, to accommodate physicians and parents. This enables key patient information to
be accessed by nursing staff and physicians caring for babies.
6C was the first unit to implement use of the
functionality of using “pre-planned” physician electronic orders. The physician enters orders for all phases of
care (recovery, post-extubation) via CPOE (Computerized Provider Order Entry) in a “pre-planned” state and
the nurse initiates the orders based on the patient’s care phase. This allows the nurse to see orders that need
to be completed in that particular care phase and reduces the possibility of error omission in a later phase.
These orders are seen in “Plans Yet To Be Initiated,” a unique Memorial feature of the CareDex. FMS also has
implemented this functionality for scheduled Cesarean sections and scheduled inductions. This functionality
will continue to be rolled out in 2013 for other patient types.