Patient falls are an important issue facing many organizations. Patient falls can lead to serious and costly injuries that in some instances may even result in death. At Norton Hospital, we are focusing on falls prevention in our efforts to reach zero harm to patients.
The Norton Hospital Falls Committee is a multidisciplinary team that includes leaders and staff from each patient care unit, Physical Therapy, Environmental Services, Transportation and Administration. The team’s purpose is to reduce and prevent patient injury from falls during a hospital stay. In July 2013, the leaders of the Norton Hospital Falls Committee performed a comprehensive examination of the current strategies used at Norton Hospital to reduce falls with injury. The Falls Committee continues on our journey to excellence by implementing multiple evidence-based strategies to bring awareness to patient safety and provide our team with the necessary tools to prevent falls.
With the help of this team, leaders focus on patients who are considered high-risk for falls. During multidisciplinary rounds, they ensure that appropriate safety interventions are in place for these patients. Gait belts are placed in consistent locations on each inpatient unit for easy access, and caregivers are educated on the proper use of gait belts for safe transferring and ambulation. Chair alarms are installed in every patient room. Employees receive hands-on education, and instructions are posted with each chair alarm. The pads used with the chair alarms are stocked in all inpatient care areas for quick access.
The Falls Committee leaders met with the inpatient nursing unit managers to develop falls reduction plans based on the staff culture and patient population of each unit in the hospital. They also collaborated with the manager of the Emergency Department to focus on early education and identification of patients at high risk for falls.
In October 2014, the Falls Committee hosted a weeklong Falls Fair, which provided education to 513 employees about bed alarms, chair alarms, gait belts and keeping patients at arm’s reach. Leaders, educators, advanced practice registered nurses, other staff and the Patient and Family Advisory Council volunteered for this event. This year, the Falls Fair expanded into a Quality Fair, which highlighted all ongoing initiatives at Norton Hospital.
Falls in the inpatient hospital setting are a true challenge, and our Behavioral Health Unit at Norton Hospital is not exempt. In fact, Behavioral Health experiences many of the same issues that medical units do, in addition to their own unique set of challenges based on their population. On Nov. 1, 2015, Norton Hospital began piloting a new falls risk assessment tool specifically for the Behavioral Health patient population.
The Norton Hospital Falls Committee’s plans for the future include focusing on increasing gait belt usage by frontline staff, monitoring the quality of our patient and family falls prevention education and increasing staff accountability. The Norton Hospital Falls Committee is just one example of the many ways Norton Hospital is continuing our journey to eliminate preventable harm to our patients.
Kathy Wesley, R.N., guides a patient on her road to recovery.
The first pediatric heart transplant at Kosair Children’s Hospital was performed in 1986, making our hospital the second in the United States to perform an infant heart transplant. The hospital has experienced a vast amount of growth since then; in 2015, we performed our 60th heart transplant. As Kosair Children’s Hospital’s pediatric heart transplant program remains the only one in Kentucky, we have formed multidisciplinary teams to meet the individual needs of patients and families based on the newest research and evidence-based practice. The teams consist of cardiovascular surgeons, nurse coordinators, bedside nursing, respiratory therapists, social workers, psychologists, child life specialists, palliative care nurses, dietitians, pharmacists, rehabilitation specialists, cardiologists, nephrologists and physicians in infectious diseases and genetics.
Children with advanced heart failure require a great deal of care and support while waiting for a heart transplant. The administration and staff at Kosair Children’s Hospital have worked diligently since 2012 to expand our Pediatric Advanced Heart Failure Program. Joshua Sparks, M.D., pediatric cardiologist with UofL Physicians – Pediatric Cardiology, and Tricia Brown, APRN, have worked alongside Elizabeth Reed, R.N., MHA, director, Patient Care Services, to develop a stellar service for the children of Greater Louisville. Multiple committees were formed to develop protocols and training in proper care for not only heart transplant patients, but also those with ventricular assist devices (VADs). Mary Lynne Shackelford, R.N., MHA, director of the “Just for Kids” Critical Care Center, also provides support and direction to the heart failure program.
Training began in 2014 to develop a highly specialized team to care for patients with ventricular assist devices. Teka Siebenaler, B.S., RRT, ECMO/VAD program manager; Stacy Flanders, R.N., MSN, CCRN, NE-BC, nurse manager, “Just for Kids” Critical Care Center; and Judy Eberenz, R.N., CRRN, NE-BC, nurse manager, Medical-Surgical Unit, have led their teams through intensive education sessions on transplant and VAD trainings. They have created units with cultures of acceptance of new innovations and therapies. The heart failure program also is supported by cardiovascular nurse coordinators Renae Akins, R.N., Violet Carey, R.N., Tracy Dilling, R.N., and Terri Massey, R.N., BSN, CPN, CCTC. They work diligently to maintain the day-to-day operations related to transplant evaluations, while also providing the bulk of patient and family education regarding heart transplants.
The Pediatric Advanced Heart Failure Program at Kosair Children’s Hospital experienced a vast amount of growth in 2015. Five heart transplants were performed between March and December, moving Kosair Children’s Hospital to a moderate-size pediatric heart transplant program. Our VAD program was also the first in Kentucky to implant a HeartWare Ventricular Assist Device and Berlin Heart EXCOR BiVAD support in children. The program went on to support two additional VAD patients to transplant and discharged to home the first pediatric patient in Kentucky with a HeartWare left ventricular assist device.
The program’s success in 2015 can be attributed to the multidisciplinary teamwork at Kosair Children’s Hospital and the evidence-based practices that were implemented. Heart failure patients at
Kosair Children’s Hospital receive the best care possible through daily multidisciplinary rounds and weekly multidisciplinary patient care conferences. The dedication of the team is evident in the outcomes we have seen and the continued work to stay ahead of changing therapies and innovations.
Terri Massey, R.N., welcomes a new patient.
With the transition and greater emphasis on health management outside the inpatient setting, it is crucial for Norton Medical Group employees to have the appropriate training for prevention and treatment modalities for patients in ambulatory care. In an effort to increase competency and patient safety, Norton Medical Group implemented a new orientation and preceptor program in August 2015. Prior to the new orientation process, new employees received one four-hour orientation session one to three months after beginning work in the office.
After meetings with directors, risk managers and employees in each clinical and nonclinical role (such as managers, licensed practical nurses, medical assistants and receptionists), it was determined that a more comprehensive orientation was necessary. An extensive literature search was conducted, but it yielded little information on orientation in ambulatory care. Feedback from meetings, research articles and needs assessments were used in creating the Norton Medical Group orientation program, with the goals of reducing safety occurrences and increasing employee retention and satisfaction. The new orientation takes place over two days within the first two weeks from the hire date.
In conjunction with the new orientation process, preceptors are recruited and trained in a two-hour preceptor program created by Norton Medical Group educators with the assistance of Norton Institute for Nursing and Norton University. The goal is to teach preceptors to effectively mentor and train new employees for a designated time period. The educators also are working on developing online preceptor modules.
To evaluate effectiveness, several factors will be monitored for one year, including the first-year turnover rate, employee satisfaction and the number of safety occurrences after initiating the programs. The results will be compared to the same information from 2014 to 2015. The team anticipates decreases in the first-year turnover rate and safety occurrences and an increase in satisfaction. A special thank-you is extended to Norton Medical Group directors, managers and employees for their continued support of the implementation of this new process.
Holly Cahall, LPN, (left) and Megan Tabor, MSN, R.N., work together in the orientation and preceptor program.
Nurses in health care today are increasingly challenged with fast-paced environments and patients with complex health issues. In this environment, support for new graduate nurses is essential. The Norton Healthcare Institute for Nursing has developed a New Graduate Nurse Residency Program designed to facilitate a successful transition from student to practice with the ultimate goal of improving patient care, outcomes and satisfaction.
The program is designed to support new graduate licensed practical nurses and registered nurses entering into practice in all levels of care within Norton Healthcare. Residents will be informed about the program during facility orientation. The program incorporates best practices in a two-element design. Element 1 consists of classroom didactic, self-directed learning as well as clinical immersion with an assigned preceptor. Element 2 consists of looping and residency workshops. The monthly three-hour workshops are designed to support the new graduate nurse’s professional development, evidence-based practice understanding, enhanced confidence in professional interactions with peers and colleagues, and reflection time.
The workshop structure will begin with three yearly cohorts. Residents will be placed in a cohort pending completion of Element 1. Each facility will have a Facility Residency Team. The team will collaborate with the Institute for Nursing in developing workshops, administering workshops and communicating metrics. The workshops will begin with a kickoff celebration to introduce the New Graduate Nurse Residency Program and outline expectations for participants’ successful completion of program.
Evidence-based practice projects will be introduced during the second residency workshop. These projects will be unit-specific/clinically specific projects that focus on topics such as quality improvement of nursing-sensitive patient care outcomes, HCAHPS and so forth. Each facility will have an on-site evidence-based practice mentor to assist with project design.
Each workshop will have time set aside to work on the project. The final workshop will be a graduation celebration with a presentation of participants’ evidence-based practice projects and a reception.
Norton Healthcare Institute for Nursing implemented the New Graduate Nurse Residency program in all five hospitals on Jan. 1, 2016.
–Carol Goss, DNP, RNBC-DNP, project leader; Julie Wolford, MSN, Nurse Residency Manager; Michele Harbin, R.N., BSN, MBA, CNOR, system nurse educator