Click on the following link to access the March issue of the MHS Quality & Patient Safety Newsletter March 2008.

When you need care, you have options.  We help you get to work when your normal care arrangements fall through.  Call us 24/7 to schedule center-or home-based care for your loved ones.  Situations include school holidays, sick caregivers, mildly ill loved ones, business travel, overtime, etc. 

See the following brochure for more information:

Back Up Care Program Flyer

You asked us to make the nursing clinical ladder more streamlined and useful. Consider it done!

Nursing Clinical Excellence Program Flyer

Announcing the new MHS Nursing Clinical Excellence Program. For more information, including the policy and application packets, please visit the Nursing Clinical Excellence link under the Your Career/Career Development section of SANursing.com.

Who are the Core Measure Resource Nurses? 

Acute MI and Heart Failure Core Measures Nurses:

Lorenia Valdez, RN, and Dusty Wade, RN, are forging a new role as Core Measures Resource Nurses.  Both began this new role on October 15, 2007, and are reporting directly to Renee R. Fletcher, MSN, RN, Nurse Director for Cardiac Rehabilitation at Methodist Hospital (MH) and Methodist Specialty and Transplant Hospital (MSTH).  Jodie Sanchez, RN, Cardiac Rehabilitation Nurse at MSTH will add this role to her current responsibilities.

Lorenia has been a MH employee for seven years and most recently worked in the CICU.  Dusty most recently worked in CVA at MSTH and prior to that in the Emergency Department at MH.  Dust is currently attending UTHSCSA School of Nursing with a goal of becoming a Nurse Practitioner.  Jodie has been a Cardiac Rehabilitation nurse at MSTH for the past three years and prior to that worked on the telemetry unit at MSTH.

Lorenia and Dusty will provide coverage seven days a week during the day shift for MH/MHH.  Jodie will provide coverage Monday through Friday during the day shift for MSTH.  All three will be responsible for identifying patients who may be diagnosed with an Acute MI or with Heart Failure.  Time sensitive issues with Acute MI are whether or not ASA and a Beta Blocker are given within 24 hours of arrival to the hospital.  Lorenia, Dusty and Jodie will follow the patient until discharge to ensure all Core Measure items are addressed.

The Core Measures nurses can be reached at 954-3575 for MH/MHH and 575-8785 for MSTH.

Pneumonia Core Measures Nurses:

Annette Medina, RN, will be helping with the core measures for Pneumonia patients at Methodist Hospital.  Annette has been a Methodist employee for many years and is well known on many units.  Her most recent position was working for the P.R.N. Squad as part of the Resource Pool.  Although usually a night shift worker, Annette will be helping at various hours of the day and night so we can improve the outcomes for our pneumonia patients.  Some of the measures for this population are very time sensitive.  The most important measure that we need to improve on is making sure that eligible patients are vaccinated for influenza and pneumococcal pneumonia.  You’ll see Annette on the nursing units following up on these measures, educating staff and making sure the vaccines are given.  Email Annette if you have any questions.

Where can you get more information about Core Measures?  Contact any of the individuals below.

Acute MI and Heart Failure
Team Leaders ~Renee Fletcher, RN (687-6284) or Jane Appleby, MD (445-1328)
MH/MHH Core Measures Nurses ~ Lorenia Valdez, Dusty Wade (954-3575)
MSTH Core Measure Nurse ~ Jodie Sanchez (575-8785)

STEMI
Team Leader ~ Linda Mann, RN (575-4695)

Pneumonia
Team Leader ~ Wendy Kuenemann, RN (575-6057)
MH/MHH Core Measure Nurse ~ Annette Medina, RN (via Meditech email)

Surgical Improvement and Infection Prevention
Claudia Wormuth, RN (575-4669)
Roberta Tremper, RN (575-6025)
Ginny Pulliam, RN (575-8550)

The art and science of caring is the cornerstone of nursing practice.  The delivery of excellent nursing care requires knowledge, compassion and competence.  Nurses are uniquely positioned to ensure that patients receive quality care.  In part, this ability requires sharing of essential clinical information with all members of the healthcare team.  This article discusses the impact that nurses have on the delivery of key components of care, known as core measures.

What is a Core Measure?
Core measures are intended to measure or evaluate the process of medical care.  These nationally determined and publicly reported measures show how often patients with a specific illness receive a treatment or intervention that has been shown by clinical studies to improve that illness.  For example, it is well established that smoking is a risk factor for heart attack.  Therefore a patient with a history of current tobacco use who is admitted to the hospital with an Acute MI should be advised to stop smoking because continuing use of tobacco increases the risk of recurrent disease. 

What Core Measures are we tracking? 
Currently we are evaluating the process of care for heart attacks, heart failure, pneumonia, surgical care improvement and infection prevention, and children’s asthma care.  The specific elements that are reported to the public for each of these diseases are shown in the table below (Table 1).

What do Core Measures mean to nursing?
Core Measures are like practice standards that guide us to give the best possible care.  At times, these standards challenge us to re-evaluate the way we coordinate and deliver care.  For example, the STEMI (ST evaluation Myocardial Infarction) team at the Methodist Heart Hospital has focused on quick assessment and triage of patients having a heart attack in addition to enhancing teamwork between the Emergency Department, the Cath Lab, nursing staff and interventional cardiologists.  Improved teamwork and communication led to 100% of STEMI patients receiving PCI (percutaneous coronary intervention) within 90 minutes of hospital arrival during the third quarter 2007.  Another example of changing the delivery of care is nursing administration of the pneumococcal and influenza vaccines based on a screening protocol rather than a physician order.

Evaluating the process of care helps us know what interventions will make a difference in quality patient care.  Additionally, examining processes can help us reassess the sequence and timing of care.  For example, clinical data suggests that administration of antibiotics soon after hospital admission is an important factor in decreasing the mortality of community acquired pneumonia.  The standard set for this measure is that antibiotics will be administered within 6 hours of arrival to the facility.  The Pnuemonia Team has worked hard to improve the efficiency of antibiotic delivery to patients admitted with a diagnosis of community acquired pneumonia.  Third quarter 2007 data shows that at Methodist Hospital (MH)/Methodist Heart Hospital (MHH) we are delivering the antibiotic within 6 hours of arrival 88% of the time and at Methodist Specialty and Transplant Hospital (MSTH) 82% of the time.  While this is marked improvement our patients will be far better off if they receive these antibiotics within 6 hours 100% of the time. 

Doctors and patients rely on nurses to provide important information at the time of discharge.  When patients understand what to do and what to expect after they leave the hospital, outcomes improve.  Important elements of discharge teaching, especially for heart failure patients, include providing information on weight monitoring, diet, activity, smoking cessation, follow-up and medications.  Working with physicians to ensure the patient receives a complete and accurate medication list at the time of discharge helps prevent adverse effects and readmissions.  The Core Measures nurses are available to work with unit staff to ensure that complete and accurate discharge instructions are given to every patient with heart failure at the time of discharge.

Nurses begin the assessment of every patient as they enter our hospitals.  Therefore, nurses can identify patients early in the hospital course that may have a “Core Measure” diagnosis.  Early identification is important to ensure we provide all of the essential elements of care.  To assist all team members in identifying these patients we have developed a color coding system.  Each disease process will be assigned a colored “dot” that is placed on the white patient name label located on the spine of the chart.  Heart Failure will be identified with a blue dot, acute MI with a yellow dot and Pneumonia with a green dot.  If you identify a patient that needs a “dot” - notify your Nurse Director to ensure that this patient receives excellent care.

Knowledge of these essential “core” elements of care and coordination of care is an important part of providing excellent care for our patients.  Nurses on the front line of care have the potential to identify opportunities to improve the process of care and bring them to our attention.  By working together we promote excellence.

Where can I get more information about Core Measures?

Acute MI and Heart Failure
Team Leaders ~ Renee Fletcher, RN (687-6284) or Jane Appleby, MD (445-1328)
Core Measure Nurses for MH/MHH ~ Lorenia Valdez, Dusty Wade (954-3575)
Core Measure Nurse for MSTH ~ Jodie Sanchez (575-8784)

STEMI
Team Leader ~ Linda Mann, RN (575-4695)

Pneumonia
Team Leader ~ Wendy Kuenemann, RN (575-6057)
Core Measure Nurse for MH/MHH ~ Annette Medina, RN (via Meditech email)

Surgical Improvement and Infection Prevention
Claudia Wormuth, RN (575-4669)
Roberta Tremper, RN (575-6025)
Ginny Pulliam, RN (575-8550)

Employees are asked to take some time to visit the core measures link on MHS Central.  This site has checklists, order sets and educational materials.

Table 1: Current Reported Elements for each Core Measure*

Acute MI:
- Percent of heart attack patients given ACE Inhibitor or ARB for Left Ventricular Systolic Dysfunction (LVSD)
- Percent of heart attack patients given Aspirin on arrival
- Percent of heart attack patients given Aspirin at discharge
- Percent of heart attack patients given Beta Blocker on arrival
- Percent of heart attack patients given Beta Blocker at discharge
- Percent of heart attack patients given fibrinolytic medication within 30 minutes of arrival
- Percent of heart attack patients given PCI within 90 minutes of arrival
- Percent of heart attack patients given smoking cessation advice/counseling

Heart Failure:
- Percent of heart failure patients given ACE Inhibitor or ARB for Left Ventricular Systolic Dysfunction (LVSD)
- Percent of heart failure patients given an evaluation of Left Ventricular Systolic (LVS) Function
- Percent of heart failure patients given discharge instructions
- Percent of heart failure patients given smoking cessation advice/counseling

Pneumonia:
- Percent of patients assessed and given pneumococcal vaccination
- Percent of patients assessed and given influenza vaccination
- Percent of patients given initial antibiotics within 6 hours of arrival to hospital
- Percent of patients given smoking cessation advice/counseling
- Percent of patients given the most appropriate initial antibiotics
- Percent of patients whose initial emergency room blood culture was performed prior to administration of the first hospital dose of antibiotics

Surgical Improvement:
- Percent of surgery patients who received preventative antibiotic(s) one hour before incision
- Percent of surgery patients who received the appropriate preventative antibiotic(s) for their surgery
- Percent of surgery patients whose preventative antibiotic(s) were stopped within 24 hours after surgery
- Percent of surgery patients with recommended venous thromboembolism (VTE) prophylaxis ordered anytime from hospital arrival to 48 hours after surgery end time
- Percent of surgery patients who received appropriate venous thromboembolism prophylaxis within 24 hours prior to surgery to 24 hours after surgery
- Percent of surgery patients on beta-blocker therapy prior to admission who received a beta-blocker during the perioperative period
- Percent of colorectal surgery patients with immediate normothermia (greater than or equal to 96.8 F) within 15 minutes after leaving the operating room
- Percent of cardiac surgery patients with controlled 6 a.m. blood glucose (less than 200 mg/dL) on postoperative day one (POD 1) and postoperative day two (POD 2)
- Percent of surgery patients with appropriate surgical site hair removal.  No hair removal or hair removal with clippers or depilatory is considered appropriate.  Shaving is considered inappropriate.

Children’s Asthma Care:
- Percent of pediatric asthma inpatients who received relievers during hospitalization
- Percent of pediatric asthma inpatients who received systemic corticosteroids during hospitalization
- Percent of pediatric asthma inpatients with documentation that they or their caregivers were given a written Home Management Plan of Care (HMPC)

*This is the most current list of core measures and may change based on nationally released clinical data.

Guest Author - Jane Appleby, MD, FACP

The National Certification Board for Diabetes Educators (NCBDE) announced that Sarah Villegas, RN, Diabetes Education Program Coordinator for MHS and Diabetes Educator, and Edward Corum, RN, Diabetes Educator have renewed their Certified Diabetes Educator (CDE) status by successfully completing the continuing education renewal option process.  Sarah has been a certified diabetes educator for 20+ years and originally opened the diabetes education office for MHS in 1986.  Ed has been a diabetes educator since 2000 and a certified diabetes educator since 2002.

Candidates must meet rigorous eligibility requirements to be eligible for certification.  Achieving the CDE credential demonstrates to people with diabetes and employers, that the health care professional possesses distinct and specialized knowledge, thereby promoting quality of care for people with diabetes.  There are currently more than 15,500 diabetes educators who hold the CDE credential.  NCBDE was established in 1986 to develop and administer a certification program for health care professionals who teach individuals with diabetes how to manage their disease.  Through the development, maintenance and protection of the certification process and the CDE credential, NCBDE recognizes and advances the specialty practice of diabetes education.  NCBDE supports the concept of voluntary, periodic certification for all diabetes educators who meet credential and experience eligibility requirements.  For more information, visit the website at www.ncbde.org or call the national office at (847) 228-9795. 

Congratulations to the following individuals for successfully Validating or Advancing through STEPP.

Frank Babauta, MH, EP Transition - Advanced RN IV

Crystal Bannister, MCH, Pedi Surg - Advanced RN III

Lisa Breedlove, MCH, NICU - Advanced RN V

Dolores Collins, MCH, NICU - Advanced RN V

Sheila M. Crescencia, Metro, NICU - Advanced RN III

Chad M. Dixon, Metro, Cath Lab - Advanced RN IV

Nora M. Ervin, MCH, NICU - Advanced RN V

Irma M. Flores, Metro, Behavioral Science - Validated RN III

Rose Gonzales, MCH, NICU - Advanced RN V

Kathleen Hubbard, MH, SICU - Advanced RN V

Patricia Johnson, NEMH, Med Monitored - Advanced RN III

Jennifer Krebsbach, MCH, NICU - Advanced RN III

Colette H. Loer, MCH, NICU - Advanced RN V

Jewel Martinez, MCH, NICU - Advanced RN V

Theresa Martinez, MCH, NICU - Advanced RN V

Judy McDonald, MCH, NICU - Advanced RN V

Pamela Lewis McPherson, Metro, SICU - Advanced RN V

Colleen Kay Palacios, Metro, Tele - Validated RN IV

Catherine M. Porter, MCH, NICU - Advanced RN V

Valerie Quinn, MCH, NICU - Advanced RN V

Becky Robertson, MCH, NICU - Advanced RN V

Adrianne M. Thomas, Metro, NICU - Advanced RN IV

Nicole Thomas, MCH, NICU - Advanced RN V

Teresa Tijerina, MCH, NICU - Advanced RN V

Felicia A. Vidal, MCH, NICU - Advanced RN V

Erika L. Wood, MCH, NICU - Advanced RN V