A Destination of Excellence:
Driving toward Culturally Competent Healthcare
DestinationExcellenceisaboutourcommitmenttoser...
CINCINNATI CHILDREN’S
Port of Call Arrival
CHILD LIFE: SEACREST STUDIO 4
SPEECH / AUDIOLOGY 6
PROJECT SEARCH 8
ASTHMA INIT...
CINCINNATI CHILDREN’SPAGE 2
CINCINNATI CHILDREN’S
Russ Garrison, OT (Occupational Therapist)
Colleagues and Friends,
Since we opened our doors in 1883, Cincinnati Children’s has
been a Destination of Excellence for ...
PAGE 4
2014
Highlights
CINCINNATI CHILDREN’S / CHILD LIFE
Seacrest Studio –
“The greatest experience I’ve ever had!”
It wa...
PAGE 5
CINCINNATI CHILDREN’S
CINCINNATI CHILDREN’S / CHILD LIFE
Caleb Hastings MT-BC
Neurologic Music Therapist
Burnet Cam...
PAGE 6
New Scheduling Style
Brings Flexibility for Families
Transportation, child care, scheduling conflicts, and simply f...
Audiologist Annmarie Wollet AuD (above).
PAGE 7
CINCINNATI CHILDREN’S
P A S S P O R T
Name
Occupation
Location
“I help mak...
CINCINNATI CHILDREN’SPAGE 8
CINCINNATI CHILDREN’S
PAGE 9
Project SEARCH
Changing the Outcome
for Young People with Disabilities
IfyouworkatCincinnatiChildren’syoulikelyshar...
PAGE 10 CINCINNATI CHILDREN’S / NURSING
International interest in importing the Project SEARCH program model
is widespread...
PROJECT SEARCH
Kristi VanVranken CTRS
Therapeutic Recreation
Specialist
College Hill Campus
P A S S P O R T
Name
Occupatio...
“Asthma is the
most common
childhood chronic
illness affecting
more than nine
million children
in the United
States.”
PAGE...
Brandy Wiener, MSW, LISW; Lauren Poling, MSW; Lisa Crosby, DNP, CNP, PMHS
CINCINNATI CHILDREN’S / NURSING PAGE 13
“Within Hamilton
County, Ohio, one
child in every
six has been
diagnosed with
asthma.”
ASTHMA INITIATIVE
persistent asthma...
Catch Your Breath-
the School / Asthma Connection
Asthma is a common, yet complex and costly chronic disease that affects
...
The program provides:
1. More training for school nurses about asthma.
2. School nurse’s limited access to electronic medi...
To accelerate improvement in asthma health, we have begun more in-
depth work with neighborhoods where asthma is a signifi...
PAGE 18 CINCINNATI CHILDREN’S / NURSING
Safe Transitioning of Patients Back Home
Non-Traditional Nurse Home Visit
A child’...
PAGE 19
HOME CARE NURSING
CINCINNATI CHILDREN’S / NURSING
experienceonascaleof 0-10,100%offamiliesratedtheirexperienceas8-...
CINCINNATI CHILDREN’S / NURSINGPAGE 20
months of age which began in May
of 2014. The second phase of the
study, the Qualit...
PAGE 22
NURSING AWARDS
CINCINNATI CHILDREN’S / AWARDS
2014 DAISY RECIPIENTS
January 2014 - Andrea Pyle BSN, RNII, Hem/Onc
...
PAGE 23CINCINNATI CHILDREN’S / AWARDS
2014 PEASE AWARD NOMINEES
2014 SPORCK AWARD NOMINEES
PAGE 24
ADVANCED DEGREES
CINCINNATI CHILDREN’S / NURSING
Nurses Who Received Advanced Nursing Degrees (MS, PhD, DNP) in 20...
PAGE 25CINCINNATI CHILDREN’S / NURSING
Melissa Najdovski
Jacqueline Napoli
Monique Neace
Tara Neary
Marla Neilson
Rachel N...
HOSPITAL FACTS AND FIGURES
Number of beds licensed 628
Number of beds staffed 561
Number of ambulatory clinic visits 500,3...
PAGE 27
HIGHEST NURSING DEGREES FOR RNS
ADN/Diploma 761
BSN 2,167
MSN 735
Doctorates 36
HIGHEST NURSING DEGREE FOR RNS WHO...
PAGE 28
Pilot Program Rotates Nurses Between
Inpatient / Outpatient Settings
A unique approach to nursing took hold in 201...
PAGE 29
ROTATION OF NURSES
“In the outpatient setting I met lots of families. It was more education
based, and I got to se...
PAGE 30
ROTATION OF NURSES
Kelly Shrout BSN, RN, CPN (left)
Kelly was working on a Cardiac/
Orthopedic inpatient unit when...
Building Healthy, Resilient Caregivers
Research shows that people who are resilient can more easily resolve
conflicts, tur...
PAGE 32
HEALTHY STAFF
Hoying Healthy Challenge
Encouraging a healthier lifestyle through proper nutrition, regular exercis...
PAGE 33
HEALTHY STAFF
Participants report:
Increased insight into the social and emotional aspects of patient care;
increa...
CINCINNATI CHILDREN’SPAGE 34
HEALTHY STAFF
why NICU staff had their own fishbowl. Four times each day, team leaders
and ch...
PAGE 35CINCINNATI CHILDREN’S / CHILD LIFE
Reuniting Sick Kids and Their Pets
Jessica Elam, a cancer patient at Cincinnati ...
PAGE 36
FAMILY PET CENTER
Radiant heat makes it comfortable except
during Cincinnati’s coldest winter days. Fire
code proh...
PAGE 37
Injuries No Longer the Norm
An occasional injury during the workday used to be the norm in the
Division of Occupat...
Elizabeth Bauer OTR/L
PAGE 38
OCCUPATIONAL THERAPY / PHYSICAL THERAPY
learning to ride a tricycle, she wished someone had ...
“We’ve learned that by
focusing on precursor
safety events and
unexpected outcomes,
we’ve been able to
significantly reduc...
PAGE 40
Antimicrobial Stewardship Program
Each year millions of lives around the world are saved by the use of
antibiotics...
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NAR2014_v16-low

Published on: Mar 3, 2016
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Transcripts - NAR2014_v16-low

  • 1. A Destination of Excellence: Driving toward Culturally Competent Healthcare DestinationExcellenceisaboutourcommitmenttoservethehealthoftheworld’scommunity. For many years Cincinnati Children’s has welcomed patients and families from around the country and the world. Today, the number of those coming from outside our 25 county service area has significantly increased. In 2014, an interdisciplinary team led the re-design of the patient intake process and care coordination. Gaining a better understanding of patients and families establishes a foundation for the staff to understand, negotiate, and realign care expectations. The new organizational priority was entitled Destination Excellence (DE). An extensive gap analysis led to an innovative partnership between Patient Services and the Office of Diversity/ Inclusion. As a result of this partnership, a Cultural & Linguistic Liaison (CLL) role was developed, piloted, and implemented. The CLL is matched to the culture and language of the patient/family they are assigned. The Liaison develops immediate trust with the patient/family and serves as a coach to ensure patient safety, a positive experience, and increased efficiency of care delivery. To increase the staff ’s knowledge, skills, and abilities in managing cross-cultural situations, the Patient Services Cultural Competency Committee (PSC3) has established the volunteer role of a Cultural Competency (C2) Champion. Within this peer-to-peer model, the C2 Champion enhances the delivery of culturally competent healthcare. Much has been done to increase our staff ’s knowledge, skills, and abilities in managing cross-cultural situations, especially during moment-to-moment patient encounters. Ongoing efforts help staff better understand diversity resources and gain a deeper understanding of culturally appropriate responsive solutions. Our mission is to improve child health and transform delivery of care through fully integrated, globally recognized research, education, and innovation for the community, the nation, and world. Motivated by the mission, these transformative changes not only impact international patients, but expand our cultural sensitivity for the growing diverse domestic patient population as well.
  • 2. CINCINNATI CHILDREN’S Port of Call Arrival CHILD LIFE: SEACREST STUDIO 4 SPEECH / AUDIOLOGY 6 PROJECT SEARCH 8 ASTHMA INITIATIVE 12 HOME CARE NURSING 18 NURSING & ALLIED HEALTH AWARDS 22 ADVANCED NURSING DEGREES 24 OPTIMAL OUTCOMES 26 CONTINUING EDUCATION 27 ROTATING NURSES 28 HEALTHY STAFF 31 CHILD LIFE: FAMILY PET CENTER 35 OCCUPATIONAL THERAPY / PHYSICAL THERAPY 37 PHARMACY: ANTIMICROBIAL STEWARDSHIP PROGRAM 40
  • 3. CINCINNATI CHILDREN’SPAGE 2 CINCINNATI CHILDREN’S Russ Garrison, OT (Occupational Therapist)
  • 4. Colleagues and Friends, Since we opened our doors in 1883, Cincinnati Children’s has been a Destination of Excellence for our patients and families. In recent years our reach has expanded significantly. In 2014 we welcomed patients from our local community, every state in the U.S., and from 57 countries. This annual report highlights some of the reasons why we’re con- sidered a Destination of Excellence. From our outstanding nurses to our incredible audiologists, therapists and other allied health professionals, this report captures the enthusiasm and dedication of our staff. Our Shared Governance approach, and our Interpro- fessional Practice Model, has empowered every employee with partnership, equity, and ownership in their respective areas of expertise. As a result, Cincinnati Children’s is home to innovative programs and practices that have improved outcomes during nearly 1.2 million patient encounters in 2014. We know that the best care is delivered by staff who are healthy and resilient. To promote resiliency, various activities in 2014 were devoted to boosting the physical, mental and emotional health of our 6,300 nursing and Allied Health staff. On behalf of our incredible caregivers, I am excited to provide you this glimpse into what makes Cincinnati Children’s a Destination of Excellence in 2014. Sincerely, Cheryl Hoying PhD, RN, NEA-BC, FACHE, FAAN Senior Vice President of Patient Services
  • 5. PAGE 4 2014 Highlights CINCINNATI CHILDREN’S / CHILD LIFE Seacrest Studio – “The greatest experience I’ve ever had!” It was a year of learning how a multimedia broadcast studio, encased in glass in the hospital lobby, can enhance patient and family experiences. In late 2013, Ryan Seacrest cut the ribbon on our Seacrest Studio, one of just eight in the nation. Since then the studio has broadcast entertainment programming to patient rooms via closed-circuit television and radio. It’s a place for patients to try their skills at being a DJ or TV reporter, play on-air games, or just hang out. Patients visit the studio to meet celebrity guests who, in the first year, included Tim McGraw, Sesame Street Live, Cincinnati Reds and Bengals players, and the cast of Wicked and Cinderella. The studio operates under the direction of media specialists Zach Wells and Suzanne Mathews. In the case of home hospice patient Meghan Hils, the studio is a creative outlet and distraction. “Zach calls me the studio’s Teen Field Correspondent,” she says. In addition to reporting from her home on news of interest to teen patients, during visits to the studio Meghan danced with Val Chmerkovskiy from Dancing with the Stars, interviewed Bengals quarterback Andy Dalton, and met American Idol favorite, Jena Irene Asciutto. Meghan gushes when she talks about the studio. “It has enriched my life. It has been the greatest experience I’ve ever had. I spend a lot of time at home, and for this to be there for me, it’s such a great distraction and such a good time,” she says, then quickly adds, “not just for me but for all the kids!”   In its first year the Seacrest Studio greeted 90 special guests, broadcast 26 original programs, provided 24 interns with firsthand broadcasting experience, and provided immeasurable learning and fun to 890 visitors.  “It’s a fun and safe place for our patients – a diversion from any stresses and anxieties of life in the hospital,” says Wells.  “Kids can come in, explore and get their minds off why they’re in the hospital.  To see the reaction on the kids’ faces when they walk into the studio, to bring them joy, is so meaningful.” Visitors 26 Original Programs 90 Special Guests 890
  • 6. PAGE 5 CINCINNATI CHILDREN’S CINCINNATI CHILDREN’S / CHILD LIFE Caleb Hastings MT-BC Neurologic Music Therapist Burnet Campus P A S S P O R T Name Occupation Location “I help make Cincinnati Children’s a Destination of Excellence for our patients and families by… bringing music into the lives of our patients to improve their hospital experience.” Home hospice patient Meghan Hils visits the studio whenever she can and calls it “the greatest experience I’ve ever had.” She is pictured at left interviewing Cincinnati Bengals quarterback Andy Dalton (above).
  • 7. PAGE 6 New Scheduling Style Brings Flexibility for Families Transportation, child care, scheduling conflicts, and simply forgetting. There are many barriers families face in getting a child to regularly scheduled therapy treatments. Using this knowledge, therapists in Speech- Language Pathology have developed a more flexible scheduling option. Family-InitiatedTreatment,orFIT,workswiththebarriersfamiliesfaceby recognizing them early and setting parents up for success. Acknowledging that some schedules are often inconsistent and hard to predict, the new program allows parents to call in and request appointments when it works for them – usually 24 hours in advance or, sometimes, the same day. Starting with the first session, therapists listen to families and work together to identify any concerns, or barriers to treatment – a procedure highlighted by the self-management initiative. Where the traditional method of scheduling appointments far in advance may not be successful, therapists recommend FIT. The flexibility of the program is often more manageable for families with parents who work night shift, have inconsistent schedules, or deal with transportation issues. “We can provide access to a greater number of families than we ever have before because we can make ourselves available when they are,” says Irv Wollman, MA, CCC-SLP, clinical director, Speech-Language Pathology. “What we’re saying is ‘call when you can, instead of call when you can’t.’” Decreasing the frequent cancellations and no-shows not only means there are more open appointments to treat children on waiting lists, but it also alleviates the sense of failure or guilt that can come from missing treatments, which can alienate families and hinder treatment. Between fall of 2013, when the program started, and January 2015, there were 930 Family-Initiated Treatments scheduled outside of the parameters of the regular scheduling system. The ability for families to choose their appointments,Wollmansays,iscrucialnotonlytoincreasingparticipation, but also to creating value in the treatments. “The focus has really been on collaborating and partnering with families more than ever before,” he says. “People will be more engaged in their health and care if they have input; if they have choice.” “We can provide access to a greater number of families than we ever have before because we can make ourselves available when they are.” CINCINNATI CHILDREN’S / SPEECH & AUDIOLOGY
  • 8. Audiologist Annmarie Wollet AuD (above). PAGE 7 CINCINNATI CHILDREN’S P A S S P O R T Name Occupation Location “I help make Cincinnati Children’s a Destination of Excellence for our patients and families by… incorporating families’ expectations of therapy outcomes into our goals, allowing them to achieve success in all environments.” Kevin McElfresh MA, CCC-SLP Speech-Language Pathologist Northern Kentucky Neighborhood CINCINNATI CHILDREN’S / SPEECH & AUDIOLOGY
  • 9. CINCINNATI CHILDREN’SPAGE 8 CINCINNATI CHILDREN’S
  • 10. PAGE 9 Project SEARCH Changing the Outcome for Young People with Disabilities IfyouworkatCincinnatiChildren’syoulikelyshareenthusiasmforProject SEARCH. This unique program helps young people with intellectual and developmental disabilities make successful transitions from school or sheltered workshops to integrated, competitive employment. It’s an innovative,one-yearprogramthattakesplaceentirelyattheworkplace.This business-led model features total workplace immersion, which facilitates a seamless combination of classroom instruction; career exploration; and internships for hands-on, worksite-based training and support. Project SEARCH is the brain child of Erin Riehle, MSN, RN and was created in 1996. Erin believes the program’s reemployment concept is a direct reflection of her nursing mindset that was nurtured at Children’s. The program demonstrates the nursing process with a holistic approach to patient care, the recognition of needs of a particular patient population, and collaboration. “I was expected to be a leader and to innovate. I was taught to investigate and had the support from leadership to act once I had all relevant information. I actually believed that it was my duty…,” says Riehle. Since that time, Project SEARCH has grown from a single program site at Cincinnati Children’s Hospital Medical Center to nearly 400 sites in a variety of businesses across the United States and in Canada, England, Scotland,Ireland,andAustralia.In2014ProjectSEARCHexperiencedan impressive growth spurt with an additional 42 new program sites. Notably, Project SEARCH programs were initiated in five states that did not previously have program sites: Kentucky, Montana, New Mexico, South Carolina, and Rhode Island. In addition, several states were involved in ongoing or newly formed statewide initiatives to facilitate introduction of the Project SEARCH program model on a larger scale. These include, Georgia, New Mexico, New York, Ohio, Texas, Vermont, and Wisconsin. Eight of the 42 new programs are located overseas, including five in England, and three in Scotland. Continued on next page “International interest in importing the Project SEARCH program model is widespread. In the near future programs are being planned in Germany, Gibraltar, Holland, India, Israel, and Wales.” CINCINNATI CHILDREN’S / NURSING
  • 11. PAGE 10 CINCINNATI CHILDREN’S / NURSING International interest in importing the Project SEARCH program model is widespread. In the near future programs are being planned in Germany, Gibraltar, Holland, India, Israel, and Wales. Project SEARCH programs serve approximately 3,500 young adults each year totaling an estimated 30,000 young adults with disabilities over the last 18 years. Of those, the rate of employment is consistently around 69.5%. This means that 20,850 young adults with significant disabilities have found employment – which means they live more fulfilling lives, work in inclusive settings, have access to employer paid benefits, have the potential for living independently and every day, are changing expectations about what it means to live with a significant disability. Eric Johnson, Erin Riehle, MSN, RN-program director, Paul Wilson, and Mary Bodle
  • 12. PROJECT SEARCH Kristi VanVranken CTRS Therapeutic Recreation Specialist College Hill Campus P A S S P O R T Name Occupation Location “I help make Cincinnati Children’s a Destination of Excellence for our patients and families by… offering children and adolescents the opportunity to address their mental health issues in unique, fun and supportive ways to improve social and cognitive functioning, build confidence, develop coping skills, and integrate skills learned in treatment settings into community settings.” PAGE 11 42 NEW SITES IN 2014 NEARLY 400SITES WORLDWIDE CINCINNATI CHILDREN’S / NURSING This is Jill Frambes, Central Sterile Processing and one of the original Project SEARCH employees at Cincinnati Children’s. S
  • 13. “Asthma is the most common childhood chronic illness affecting more than nine million children in the United States.” PAGE 12 CINCINNATI CHILDREN’S / NURSING Imagine the Panicked Feeling of Being Unable to Catch Your Breath Now picture the look of desperation on your child’s face as he or she struggles to breathe, and the helplessness you feel because you weren’t able to get their asthma medication refilled or picked up from the pharmacy. For a growing population of pediatric asthma patients in Hamilton and Butler Counties of southwestern Ohio, the situation just described is no longer commonplace thanks to an innovative collaboration with local pharmacies led by Lisa Crosby, DNP, CNP, PMHS. Asthma is the most common childhood chronic illness affecting more than seven million children. Although recent medical advances have significantly improved the overall morbidity and mortality for asthma, African-American children from low socioeconomic and inner-city backgrounds remain adversely affected by asthma. Numerous studies have identified and documented various barriers impeding positive health outcomes associated with asthma for African American children; specifically, medication adherence. Medication adherence is influenced by several factors. One significant barrier is merely obtaining a child’s Inhaled Corticosteroid (ICS) inhaler. Obtaining medications in a timely manner is often hampered by logistical or financial problems. To alleviate thisobstacle,Lisaformedimportant partnerships with local pharmacies tapping into recent advancements in technology for prescription refill automation. The work was often tedious, sometimes frustrating, and never simple. Through partnering with local pharmacies offering automated refills and home delivery of medications, Lisa was able to impact the overall rate of adherence. The target population for this intervention was children with Kathy Jaeger BSN, RN Allergy Nurse Green Township Neighborhood P A S S P O R T Name Occupation Location “I help make Cincinnati Children’s a Destination of Excellence for our patients and families by… using my 20 years of experience to ensure they receive quality, family-centered care in a safe environment.” Continued on next page
  • 14. Brandy Wiener, MSW, LISW; Lauren Poling, MSW; Lisa Crosby, DNP, CNP, PMHS CINCINNATI CHILDREN’S / NURSING PAGE 13
  • 15. “Within Hamilton County, Ohio, one child in every six has been diagnosed with asthma.” ASTHMA INITIATIVE persistent asthma, ages 2-17 years, in Hamilton County, Ohio, on Medicaid and enrolled in Care Coordination at Children’s Primary Care Clinic. The goal was to increase the ICS fill rate from 20% to 50%. Lisa initially enrolled a cohort of 25 children in the intervention program to have their ICS automatically refilled and delivered on a monthly basis. The pre-intervention average baseline for this cohort was 20%. Utilizing small tests of change and immediate feedback during the improvement period, the median ICS fill rate at sixteen months post-intervention was 89%. The average post-intervention monthly fill rate was 80%. By March 2014, Lisa’s program had spread to Butler County and two other Cincinnati Children’s primary care clinic locations, yielding 130 patients actively enrolled in the program. Lisa’s work with pharmacy delivery intervention has demonstrated increased ICS fill rates among children with asthma from our most vulnerable populations. An increase in the number of ICS filled has been shown to directly correlate with decreased asthma morbidity. As a result of the outcomes from this work, Lisa is now examining the Asthma Control Test score for this group as a measure of adherence to the asthma medication regimen.
  • 16. Catch Your Breath- the School / Asthma Connection Asthma is a common, yet complex and costly chronic disease that affects more than nine million children in the United States under age 18. It causes hundreds of thousands of hospitalizations and several thousand preventable deaths each year, and results in overall healthcare costs in excess of $20 billion. Within Hamilton County, Ohio, one child in every six has been diagnosed with asthma, a figure that increases significantly for children who live below the poverty line. The Cincinnati Children’s Hospital Medical Center’s 2015 strategic plan calls for the hospital to lead, advocate and collaborate to improve the health of local children with asthma. Cincinnati Children’s has been proactive in reaching out into the community via school nurses since 2006 to address this issue. In 2014 we expanded our asthma education program from eight school locations to the entire Cincinnati District of 55 schools. PAGE 15 ASTHMA INITIATIVE CINCINNATI CHILDREN’S / NURSING Continued on next page
  • 17. The program provides: 1. More training for school nurses about asthma. 2. School nurse’s limited access to electronic medical records (student’s asthma action plan, medications). 3. Phone huddles with a) school nurse, b) Cincinnati Children’s asthma care coordinator, c) a pulmonary nurse. All of these interventions result in increased school attendance for children and increased work time for their parents. A Breath of Fresh Air: An Instructional Video Starring Your Child It’s common to send an asthmatic child home from the hospital with written discharge instructions. We’ve found it’s more effective to demonstrate the proper use of an inhaler with the patient starring in their own instructional video. During a hospital admission, families undergo a standardized asthma risk assessment to guide individualized referrals to promote optimal care after discharge. Referrals include a Home Health Pathway to support care and self management, referral to an asthma specialist and referral to a home environmental risk identification and abatement program. Patients also leave the hospital with medications in hand to manage their asthma. In addition, high-risk Cincinnati Children’s primary care patients work with an asthma care coordinator to reduce barriers to optimal care. In partnership with Cincinnati Public Schools, the Cincinnati Health Department and the Growing Well network, we have developed a screening process to identify children attending Cincinnati Public Schools with inadequately controlled asthma. PAGE 16 CINCINNATI CHILDREN’S / NURSING Laura L Kelly BSN, CPN, RN Allergy Nurse Green Township Neighborhood P A S S P O R T Name Occupation Location “I help make Cincinnati Children’s a Destination of Excellence for our patients and families by… striving to provide quality, safe care that exceeds their expectations.” ASTHMA INITIATIVE
  • 18. To accelerate improvement in asthma health, we have begun more in- depth work with neighborhoods where asthma is a significant health issue. Starting with the neighborhood of Avondale, near where our main campus is located, our goal is to create an integrated asthma program that engages schools, other primary care providers and the broader community, resulting in measurably improved outcomes for children with asthma. To accelerate improvement in asthma health, we have begun more in-depth work with neighborhoods where asthma is a significant health issue. Other innovative approaches to reaching asthmatic kids: • Assigned care coordinators • Video visits vs. phone calls for more effective follow-up • Smart-halers that electronically monitor medication use • Social media assessment tools to motivate compliance • Pre-programmed reminders via text to take meds School nurse, Laura Olexa, at the Academy of World Languages. (left) PAGE 17CINCINNATI CHILDREN’S / NURSING ASTHMA INITIATIVE
  • 19. PAGE 18 CINCINNATI CHILDREN’S / NURSING Safe Transitioning of Patients Back Home Non-Traditional Nurse Home Visit A child’s discharge after hospitalization heightens the responsibility of any parent. Their role expands to include not only parenting, but also clinical care during their child’s home-based recovery period. The newest innovation of in-home care at Cincinnati Children’s is the provision of a comprehensive nursing assessment, conducted within 48 hours after home arrival to patients discharged from a general medical-surgical unit. During a nurse executive trip to Cuba in 2011, Dr. Cheryl Hoying was introduced to the concept of the non-traditional nurse home visit as part of the plan of care for recently discharged patients. Her observation of this practice led to a home care pilot program at Cincinnati Children’s in 2012. This unique home visit program offers families an option to continue medical care at home post discharge and is available to families in Kentucky, Indiana and Ohio, seven days a week, free of charge. As of December 2014, Cincinnati Children’s has completed 1,067 home visits in this pilot. Despite a child being physiologically ready for discharge, Cincinnati Children’s inpatient staff sometimes noted a lack of parents’ confidence in caring for their child at home leading to extended inpatient stays. The post-discharge nursing, in- home assessment promotes the confidence of parents by providing a timely validation of their child’s clinicalstatus.Thenursecompletes a comprehensive assessment of systems, observes medication management, reviews adherence to the treatment plan, views the environment of care, answers clinical questions and coordinates with primary care or subspecialty services regarding outstanding concerns. When surveyed on their Teri Fetters, RNII, CPN, Home Care Agency
  • 20. PAGE 19 HOME CARE NURSING CINCINNATI CHILDREN’S / NURSING experienceonascaleof 0-10,100%offamiliesratedtheirexperienceas8-10. Familiesalsonotedtheirexperienceofreassurancewhenthenurseconfirmed theywerecaringfortheirchildappropriatelyandtheirchildwasimproving. Two examples of home visit safety catches: • In-Home medication reconciliation: A home health nurse identified a ten-fold error in written dosing instructions. She contacted the physician to remedy the situation and arrange for a clinic follow-up. Her attention and intervention potentially averted a serious safety event. • Early intervention for condition deterioration: During a non- traditional home visit for recent discharge from the hospital related to pneumonia, a patient appeared compromised upon assessment. The patient was very fatigued and anxious, breathing loudly and heavily at times. He had difficulty responding to the nurse due to a moist cough and breathlessness. The mother reported poor appetite and marginal liquid intake throughout the day. The RN assisted the patient with an Albuterol administration and immediately instructed the mother to takethechildtotheEmergency DepartmentatCincinnatiChildren’s Liberty Township location for evaluation. The success of this initial pilot program led to the Patient-Centered Outcomes Research Institute (PCORI) grant initiated in February of 2014. The goal of the grant is to demonstrate the value of a nurse home visit to reduce unplanned health system utilization. The PCORI grant is a $1.5M award to study transitions from hospital to home for acute care pediatric patients. We are in the first year of the three year randomized control study. Patient participants in the study are over 18 Continued on next page “The post-discharge nursing, in-home assessment promotes the confidence of parents by providing a timely validation of their child’s clinical status.” P A S S P O R T Name Occupation Location “I help make Cincinnati Children’s a Destination of Excellence for our patients and families by… helping to support them through crisis and preparing them to return safely to the community.” Brittney Jones BSN, RN Psychiatric Nurse College Hill Campus
  • 21. CINCINNATI CHILDREN’S / NURSINGPAGE 20 months of age which began in May of 2014. The second phase of the study, the Quality Improvement process ran through January of 2015. Currently we are engaged in the Randomized Control Trial and will complete analysis by April of 2017. Keep an eye out for the published findings of the PCORI grant and theongoinginnovationshappening in Cincinnati Children’s Home Care Department. HOME CARE NURSING Ann Segers BSN, RN Nurse Headache Center Name Occupation Location “I help make Cincinnati Children’s a Destination of Excellence for our patients and families by… maintaining my passion and dedication to achieving the best outcomes for the patients we see in the Headache Center.” P A S S P O R T “Nurse home visit assessments have identified children whose physiological status had deteriorated since discharge. Immediate interventions have averted poor patient outcomes on several occasions.” Greg Meyer, RRT
  • 22. PAGE 22 NURSING AWARDS CINCINNATI CHILDREN’S / AWARDS 2014 DAISY RECIPIENTS January 2014 - Andrea Pyle BSN, RNII, Hem/Onc February 2014 - Gerry Hennies RNIII, GI Clinic March 2014 - Kristin Westerfield BSN, RN, NICU April 2014 - Jodi Jacobs NP, MSN, CBDI May 2014 - Susie Pauley BSN, RN, CICU June 2014 - Missy Hosmer BSN, RNII, CPN, A7N July 2014 - Kim Shepard RNII, Liberty SDS August 2014 - Debbie Williams RNII, CNOR, Liberty Periop September 2014 - Penny Bowden BSN, RN, HHC October 2014 - Derek Florence BSN, RN, B6HI November 2014 - Danielle Dixon BSN, RN, A5N December 2014 - Tiffany Scherer BSN, RN, B6HI 2014 NIGHTINGALE AWARD NOMINEES Lisa Adamson, BSN, RN, CNRN Stephanie Allen, RN Lisa Burns, MSN, RN, CPN Carrie Carnohan, BSN, RN, CPN Susan Council, MSN, RN, CPN Sarah Fojtik, RN Julie Fugazzi, RN John Gennett, BSN, RN Megan Gilliam, BSN, RN, CPHON Carly Heckmann, BSN, RN Anna Herbert, BSN, RN, CPHON Matthew McConnell, BSN, RN, CPN Barbara McMullen, BSN, RN Beth Moeves, BSN, RN Brianne Owens, BSN, RN Anne Pearson, BSN, RN April Pursley, BSN, RN Janet Randall, RN Julie Ranz, RN Mary Ann Sackenheim, BSN, RN Julie Schletker, BSN, RN, CPN Missy Snodgrass, RN 2014 PEASE AWARD NOMINEES Annamarie Borich, MSN, RN Mary Friend, BSN, RN, CPN Amy Haering, DNP, RN, CPN, NE-BC Sharon Kadon, BSN, RNIII, CPN Lori Puthoff, MSN, RN Darcie Rockstroh, BSN, RNII, Award Recipient Carol Tierney, PhD, RN, NEA-BC Rachel Wilson, BSN, RN 2014 SPORCK AWARD NOMINEES Michele Armstrong, RN, CEN, EMTP Angela Aull, MSN, RN III, CPN Annamarie Borich, MSN, RN, Raquel Campbell, BSN, RNII, Tabitha Carlotta, RNII, Emily Cosgrove, BA, RNIII, RNC-NIC Mandy Dahlinghaus, RNII Nicole Durr, BSN, RNIII, Mary Friend, BSN, RN, CPN, Rebecca Hearne, RNII Julie Howell, BSN, RNII, CPN Joanne Jacob, BSN, RNII, RNC-NIC Sharon Kadon, BSN, RNII, CPN Nikki Kneflin, BSN, RNIII, CPN Jeff Kuhn, BSN, RN, CCRN Elizabeth LaTulippe, BSN, RNIII, CPN Tina Russell, RNII, Stephanie Scheidt, BSN, RNII Linda Waechter, RNIII, C-NPT Shannon Wanderski, BSN, RNII, Award Recipient 2014 ALLIED HEALTH AWARDS Ann Brandner Award for Excellence in Social Work Yvonne Stepter, MSW, LISW, Award Recipient Zenith Award for Leadership in Respiratory Care Tonia Garrett, RRT, RTII, Award Recipient
  • 23. PAGE 23CINCINNATI CHILDREN’S / AWARDS 2014 PEASE AWARD NOMINEES 2014 SPORCK AWARD NOMINEES
  • 24. PAGE 24 ADVANCED DEGREES CINCINNATI CHILDREN’S / NURSING Nurses Who Received Advanced Nursing Degrees (MS, PhD, DNP) in 2014 Kelsey Abel Heather Alexander Jessica Andres Tamika Auld Rebecca Sue Bailey Victoria Bailey Neumann Christina Baker Darrell Baker Morgan Baker Kristy Bamberger Sharon Banschbach Kayla Bayer Kristi Beadle Sydney Beiting Jessica Bingham Denielle Bischoff Robin Boehm-Bier Anne Bosche Lindsay Boyer Amy Brandt Robin Brannen Donna Bredenberg Amanda Bremer JoAnna Brougham Meredith Brueggemann Marianne Brunner Jessica Bruns Kelly Bruns Chelsea Buechler Amber Burnett Megan Burriss Erin Butt Anna Butts Jessica Byington Emily Caldwell Judy Callahan Kara Cameron Raquel Campbell Olivia Caradonio Tammy Casper Erin Cassaro Lindsay Chadrick Kimberly Chaney Janis Chiarenzelli Priscilla Clark Kelli Clear Patricia Cloud Lori Combs Meredith Cornely Marissa Couto Karen Daly Michelle Daniel Tisha Danzinger Chelsey Daugherty Kristen Daughters Kara Day Tammie Day Theresa Deck Shannon Deidesheimer Barbara Denicola Elizabeth Dewar Kimberly Dietrich Anne Marie DiGioia Ashley Dishion Brenda Diver Elizabeth Dixon Kathryn Doloresco Melissa Dowler Juanita Dudley Sarah Eberts Julie Elfers Kristen Elias William Enderle Lauren Erickson Kelly Ernst Kelly Fahey Katrina Fananapazir Gwen Feldhaus Rachel Felts Brittney Fey Victoria Figg Shannon Flaherty Jerry Flynn Sarah Fojtik John Forbes Johnna Forman Jennifer Forster Suzanne Fraiche Kellie Freudemann Shelby Frey Kristen Fries Heidi Frondorf Cynthia Frye Gabriela Galligani Megan Gallo James Gelement Wanda Gerlach Barbara Giambra Michael Glass Sheryll Golden Katherine Gormas Lauren Grabowski Rebecca Gunn Katelyn Haas Lauren Hambrick Christopher Hannah Katherine Harms Kristina Harrison Chelsea Hawkins Rebecca Hearne Lisa Heaton Tammy Heflin Vicky Hellmann Andrea Hempel Caitlin Hensley Katherine Herndon Paige Herrmann Abby Hess Donna Hettinger Kelly Hicks Molly Hicks Charlene Hines Kelley Hoban Mary Housh Michelle Huffman Alicia Hujo Amanda Huschart Jessica Huwer Nicole Inman Alyssa Jackson Ashley Jansen Bridget Johantges Brent Johnstone Erin Jones Natalie Rae Kallmeyer Hayley Kanta Rebecca Kautz Kristen Kayse Stephanie Keane Jorden Kees-Futscher Kimberly Keith Erin Kelley Marsha Kerdolff Cathy King Michele Kirn Kristen Kleiner Jennifer Klueppelberg Kerry Kohler Rachel Kohlman Logan Konitsch Aimee Lynn Kraemer Jacob Kreuzmann
  • 25. PAGE 25CINCINNATI CHILDREN’S / NURSING Melissa Najdovski Jacqueline Napoli Monique Neace Tara Neary Marla Neilson Rachel Nelson Sherri Newberry Kelli Niehaus Robyn Nolan Lynne O’Donnell Jennifer Oehler Elizabeth Overman Ashley Palumbo Devin Patton Morgan Pennekamp Ashley Pennington Kristin Perdiew Serena Phillips Abby Pitman Raymuth Price Rebecca Quarles Breyanna Radford Rachel Ransick Caroline Rettig Ellen Reynolds Robin Richards Sharon Riley Kelsey Roat Darcie Rockstroh Patti Roese Stefani Rojek Maureen Rooney Elizabeth Rose Lisa Routt Katherine Russo Alyssa Sajna Reena Saks Ryan Sanders Sarah Krieg Stephanie Kruse Megan Larkins Kyra Laupp Katherine Lawrence Betsy List Kelsie Ludwig Corrie Lusk Molly-Melissa Lutz Stephanie Lux Julie Lykins Allie Mains Arielle Marasligiller Tonya Masur Jennifer Mattei Cathryn Maurer Marcia Maurer Brandy May Samantha Mayer Kelly McDonald Molly McKee Megan McKinley Christina Meadows Anna Meibers Allison Miller Crystal Miller Hillary Miniard Marissa Mishne Shawn Mock Shelby Moeller Ellen Moore Samantha Moran Jennifer Moretz Melanie Morris Theresa Mottes Leah Mousa Jennifer Murray Sarah Myers Shannon Sarver Monica Savoti Sara Scaggs Sara.Beth Schaeper Theresa Schmidt Christin Schneider Katarina Schneider April Schnelle Jenna Schnitker Emily Schuetz Allison Schulten Blaire Shamoun Rachel Sheets Kimberly Shepherd Lois Siegle Ellen Skalski Erin Slater Allison Smith Edward Smith Jennifer Smith Jessica Smith Rebecca Smith Shannon Smith Amanda Snyder Andrea Snyder Jennifer Sorrell Maggie Spindler Emily Stapp Natalie Starr Heidi Staudigel Cheryl Steinemann Alexis Stewart Ellie Sullivan Lucille Sullivan Sarah Sumila Julie Sunderman Stephanie Szlosek Kim Taylor Kristina Tingle Madison Towler Ellen Tucker Brooke Vogelsang Guy Vollrath Dana Vorst Linda Waechter Colleen Waggoner Joseph Wagner Erica Wales Ann Walterman Angela Wamsley Rebekah Wang Devin Warnecke Megan Watts Shana Weghorn Amanda Weiglein Allison Werling Arianna West Andrea Westfall Amy West-Poley Marguerite Wevers Abigail Whitehead James Williams Katelynn Williams Michaela Williams Erin Williamson Rachel Wilson Sarah Witte Kelly Wood Jordan Wyrick Lacey Yeager Kimberly York Sarah Yost Mary Youtsey Benjamin Zeinner Kathryn Ziegler Megan Zurkuhlen
  • 26. HOSPITAL FACTS AND FIGURES Number of beds licensed 628 Number of beds staffed 561 Number of ambulatory clinic visits 500,320 Number of admissions 18,951 Number of RN FTEs 2,989 RN skill mix 87.9% RN turnover rate 6.6% RN vacancy rate 6.1% PROFESSIONAL DEVELOPMENT Percentage of certified direct care RNs 30.6% Percentage of certified RNs serving in leadership positions 74.1% Total number of RNs who have nationally recognized certification 1,260 Total number of RNs who are members of at least one professional nursing organization 675 CONTINUING EDUCATION INFORMATION Number of Nursing Grand Rounds (NGR) live presentations 12 Number of nurses who attended NGR 399 Number of nurses who attended NGR online 1,404 182 other online clinicians across 10 US states and 2 countries STUDENT INFORMATION Undergrad Cohort Groups 209 Undergrad students completing clinicals 1,418 Graduate students completing clinicals 92 Role transition and leadership students 135 Total nursing students 1,645 PAGE 26 2014 In Review OPTIMAL OUTCOMES CINCINNATI CHILDREN’S / NURSING
  • 27. PAGE 27 HIGHEST NURSING DEGREES FOR RNS ADN/Diploma 761 BSN 2,167 MSN 735 Doctorates 36 HIGHEST NURSING DEGREE FOR RNS WHO PROVIDE DIRECT CARE (BY PERCENTAGE) ADN/Diploma 24.6% BSN 67.4% MSN 7.9% Doctorate .1% HIGHEST NURSING DEGREE FOR RNS IN LEADERSHIP POSITIONS ADN/Diploma 1.2% BSN 20.5% MSN or other master’s degree 75.0% Doctoral Degree 3.3% NUMBER OF EMPLOYEES WHO RECEIVED NURSING DEGREES IN 2014 ADN 21 BSN 253 MSN 66 Doctorate 5 Total 345 CONTINUING EDUCATION
  • 28. PAGE 28 Pilot Program Rotates Nurses Between Inpatient / Outpatient Settings A unique approach to nursing took hold in 2014 at Cincinnati Children’s. In pilot projects, nurses rotated working between inpatient and outpatient settings. The anticipated outcomes included: 1. Being able to see patient’s progress along the care continuum. 2. Increasing discharge teaching 3. Decreasing burnout by providing nurses with a break from a highly intense/acute area (such as CICU) to a clinic setting (such as Cardiology Clinic). 4. Increasing job satisfaction (less weekend, holiday and night shifts in the Outpatient setting). 5.Maintaining skills and technical competence. After piloting the project with six nurses in three specialties, the project was expanded to 19 nurses in 10 specialties. The end goal is for newly-hired nurses to permanently rotate between settings within the same service line, spending half of their work week in each setting. An IRB-approved research study is underway to determine the impact of the cross-setting role on nurses’ perspective of practice and job satisfaction. Rachel Schrand BSN, RN, CPN (left) Rachel was working an inpatient unit (orthopedics, urology, plastics post- op) when she applied for a six-month assignment as an Orthopedic Outpatient nurse. The assignment included working Inpatient one day every-other-week. The new role meant Rachel worked in a different Cincinnati Children’s clinic nearly every day of the week. CINCINNATI CHILDREN’S / NURSING
  • 29. PAGE 29 ROTATION OF NURSES “In the outpatient setting I met lots of families. It was more education based, and I got to see the kids progress with each visit.” Sometimes Rachel would see a patient that she had seen earlier when she worked Inpatient. Did it broaden her knowledge? “Gosh yes!” she says. “I know so much more about Orthopedics than I ever did before.” Jodi Engelhardt BSN, RN (right) Jodi was working in Cincinnati Children’s Dialysis clinic when she got the opportunity to spend part of each week in the hospital’s Nephrology clinic. Although both roles were outpatient, her experience shows the benefits of rotating assignments. “I was always interested in Nephrology, and thought the work would teach me to be better with patient care in both clinics,” she says. She often sees the same patients in both clinics. “Two transplant patients whom I saw in Nephrology indicated it was a comfort that they already knew me from my work in Dialysis. Overall, I gained from the experience, and I think the patients did too.” CINCINNATI CHILDREN’S / NURSING Continued on next page
  • 30. PAGE 30 ROTATION OF NURSES Kelly Shrout BSN, RN, CPN (left) Kelly was working on a Cardiac/ Orthopedic inpatient unit when she got the chance to also work in the hospital’s Cardiac clinic. Working one clinic shift each week, Kelly says “my role was to help out in any way I was needed while getting a different view of nursing.” During the six months that she worked both positions, Kelly says she “learned a lot about the outpatient world that has helped me be a better inpatient nurse. I understand the flow better, and when the clinic needs to admit patients late in the day, I better understand the reasons.” Although Kelly has returned to working inpatient full- time – “I like the acuity on the inpatient unit” – she says the experience was eye- opening, and as a result, she now is part of a committee aimed at improving patient flow. Ananda Pienaar BSN, RN Psychiatric Nurse Lindner Center of HOPE P A S S P O R T Name Occupation Location “I help make Cincinnati Children’s a Destination of Excellence for our patients and families by… using evidence-based practice to bring HOPE to the treatment of adolescents struggling to be set free from the control of an eating disorder.” CINCINNATI CHILDREN’S / NURSING PHOTO OF KELLY SHROUT PAGE 30
  • 31. Building Healthy, Resilient Caregivers Research shows that people who are resilient can more easily resolve conflicts, turn disruptive changes into new directions, and become more successful and satisfied along the way. Resilient employees not only can be beneficial to patients and families, they can be good role models for their co-workers too. During 2014 we focused on implementing programs and activities to improve the health and wellness of staff, and enhance resiliency. Walking Desks Employees who spend most days sitting at a desk can get a mental boost from a quick exercise break. To make those breaks easier to take, walking desks were installed in Cincinnati Children’s Occupational Therapy/ Physical Therapy Unit, and in the Specialty Resource Unit. The desks provide the opportunity to walk-in- place while working on a laptop, or taking a break. One frequent walker stated,“Thedeskisagreatwaytoboost my energy level and decrease my stress after long periods of sitting. I love that I can be active at work while still completing my job responsibilities.” Cheryl Hoying PhD, RN, NEA-BC, FACHE, FAAN senior vice president of Patient Services utilizes the walking desk in her office daily. Continued on next page
  • 32. PAGE 32 HEALTHY STAFF Hoying Healthy Challenge Encouraging a healthier lifestyle through proper nutrition, regular exercise and healthier habits is the goal of “Hoying’s Healthy Challenge.” In each quarterly challenge, senior vice president Cheryl Hoying PhD, RN, NEA- BC, FACHE, FAAN invites the Patient Services Division to participate in an activity that boosts physical, mental or emotional health. Participants can earn points in our workplace wellness program. In 2014 more than 1,000 staff routinely “accepted” Hoying’s challenge each quarter. Challenges have included: 1) Trying a new vegetable each week for four weeks. 2) Doing one new thing each week for four weeks that will result in less stress and a calmer holiday season. 3) Completing a triathlon over a four-week period. 4) Kicking a bad habit. Relieving Staff Stress The stresses of today’s healthcare system threaten the delivery of compassionate care. Schwartz Center Rounds® , implemented at Cincinnati Children’s in 2014, provide an outlet to openly and honestly discuss the social and emotional issues caregivers face in working with patients and families. Each monthly session begins with panelists from diverse disciplines, including physicians, nurses, social workers, psychologists, and allied health professionals who share an experience on an identified case or topic. Afterwards, caregivers in the audience are invited to share their own perspectives on the case and broader related issues. Topics have included: “My first experience with death,” and “Running on empty.” “During 2014 we focused on implementing programs and activities to improve the health and wellness of staff, and enhance resiliency.” CINCINNATI CHILDREN’S / PATIENT SERVICES Chris Kist MS, HFS Exercise Physiologist Northern Kentucky Neighborhood P A S S P O R T Name Occupation Location “I help make Cincinnati Children’s a Destination of Excellence for our patients and families by… ensuring every patient gets the time and attention they deserve at every visit.”
  • 33. PAGE 33 HEALTHY STAFF Participants report: Increased insight into the social and emotional aspects of patient care; increased feelings of compassion toward patients; and increased readiness to respond to patients’ and families’ needs. Improved teamwork, interdisciplinary communication, and appreciation for the roles and contributions of colleagues from different disciplines. Decreased feelings of stress and isolation, and more openness to giving and receiving support. Assistance from police psychologist. We work in an environment focused on providing the best possible medical and quality of life outcomes. So when a serious safety event occurs, the effect on staff can be devastating. To improve resiliency during these difficult times, Cincinnati Children’s has enlisted the help of a local police psychologist who routinely assists law enforcement staff in stress management and counseling of police officers and families. The psychologist counsels staff in managing the anxiety and tension that typically follows a traumatic event, and with returning to the health care setting. While the hospital setting is different, the counseling helps staff regain a sense of self-control. Gauging stress. The noise of construction can be difficult to handle when caring for critically ill patients. In 2014, during months of construction in our Neonatal Intensive Care Unit (NICU), staff wanted to be certain that parents were getting the support they needed. They asked them to place a yellow, orange or red fuzzy ball into a fishbowl at the Unit’s reception desk to indicate if they were getting the support they needed. When orange or red balls made their way to the fishbowl, it was time for a staff huddle to determine why. Construction noise can also adversely affect caregivers. That’s CINCINNATI CHILDREN’S / PATIENT SERVICES Continued on next page
  • 34. CINCINNATI CHILDREN’SPAGE 34 HEALTHY STAFF why NICU staff had their own fishbowl. Four times each day, team leaders and charge nurses used colored balls to gauge stress. Results were charted. Whenstresswashighitwastimetofindoutwhy,andtomakeadjustments. Taking fun seriously. Incorporating exercise and fun into the workday can be a great stress reliever. In 2014 we invited staff to participate in monthly “Dress-Up Days” to have some fun with co-workers and patients. We’ve celebrated the start of a sports season by wearing our favorite team’s jersey, donned our silliest hats, and paired our stripes and plaids for a “Mismatch Day.” Other resiliency-boosting events for staff in 2014 included: 1) our annual Fitness on the Field event at the Cincinnati Bengals stadium, 2) neighborhood walks and weekend hikes led by hospital leadership, and 3) incorporating ideas for maintaining a healthy mind, body and financial stability during new staff orientation. Child Life Specialist Ashley Fiffick CCLS and Holistic Health Specialist Judy Molique LMT show their Cincinnati pride during a monthly Dress-Up Day. HEALTHY STAFF
  • 35. PAGE 35CINCINNATI CHILDREN’S / CHILD LIFE Reuniting Sick Kids and Their Pets Jessica Elam, a cancer patient at Cincinnati Children’s, spent so much time in and out of the hospital fighting cancer, she knew too well the pain of not being able to spend time with her beloved dogs Sierrah and Trevor. So she made it her goal to see that other kids wouldn’t feel that same pain. In 2014, thanks to Jessica’s efforts and a grant from Impact 100, the Pet Center at Cincinnati Children’s Hospital was the site of multiple reunions between sick children and their beloved pets. Gabe Duplechian is one of dozens of patients who benefited from Jessica’s efforts. After spending three straight weeks in isolation due to a bone marrow transplant, Gabe was reunited with his dog Jackson, a boxer-mix. “They took me outside into a play area. Jackson jumped on top of me. It was probably the best day I had during my whole month in the hospital,” he remembers. Of the visit that lasted an hour, Gabe’s mom Adrienne says, “it was the brightest we had seen Gabe the entire time he was hospitalized.” Since the Center opened, dogs, cats, a guinea pig and rabbit have enjoyed visits with their owners. Many families indicate the reunion is the first time things felt “normal” since their child was admitted. The Center, believed to be the only one of its kind in the country, is mostly-indoor. Continued on next page “The Pet Center at Cincinnati Children’s Hospital was the site of multiple reunions between sick children and their beloved pets.”
  • 36. PAGE 36 FAMILY PET CENTER Radiant heat makes it comfortable except during Cincinnati’s coldest winter days. Fire code prohibits full enclosure. Pet visits are available to children who have been hospitalized five or more days, pending approval by their medical team. Many children haven’t seen their pet in months. Their emotional reunions are exactly what Jessica Elam had in mind says her mom Amy, a Cincinnati Children’s customer service representative. Jessica lost her battle with cancer at age 19, shortly after the Center opened. Kaitlyn Laskey MS, CCC-SLP Speech-Language Pathologist College Hill Campus P A S S P O R T Name Occupation Location “I help make Cincinnati Children’s a Destination of Excellence for our patients and families by… treating them the way I would want my family treated.” CINCINNATI CHILDREN’S / CHILD LIFE
  • 37. PAGE 37 Injuries No Longer the Norm An occasional injury during the workday used to be the norm in the Division of Occupational Therapy, Physical Therapy and Therapeutic Recreation (OT/PT/TR). “We just kind of expected that we’d be injured at some point due to the number and complexity of our daily patient interactions,” explains Elizabeth Bauer OTR/L, OT/PT Coordinator and Safety Domain Leader. Her colleagues agreed. Things changed in 2014. That’s when the division set out to establish a transformational safety culture. Since then, staff and patient injuries have been markedly reduced, andtheywent479dayswithoutanOSHArecordableevent.“Inanutshell, safety was always a priority; now it’s a value,” says Elizabeth. Through leadership participation in Advanced Improvement Learning Series (AILS), performance gaps were identified and safety goals established. Developing a safety domain (a team that provides executive oversight of safety issues/concerns within the division) was an important first step. Next, with a goal to eliminate all Serious Safety Events and serious harm through transforming their safety culture, the division took these strategic steps: • Safety became a standing agenda item at all meetings. At one meeting, for example, staff was encouraged to kindly remind co- workers if they notice unsafe practices. “Telling a co-worker they are doing something unsafe can be sensitive, so we role- played during the meeting to make it easier,” says Elizabeth. Managers lead by example, adds Brian Cunningham, Quality Improvement Systems. “We all make mistakes. When a supervisor forgot to put a helmet on a child who was Mike Kiefer PT, DPT Physical Therapist Floater P A S S P O R T Name Occupation Location “I help make Cincinnati Children’s a Destination of Excellence for our patients and families by… working closely with patients and families to meet the goals that are important to them in an environment that is fun and enthusiastic.” CINCINNATI CHILDREN’S / OCCUPATIONAL & PHYSICAL THERAPIES
  • 38. Elizabeth Bauer OTR/L PAGE 38 OCCUPATIONAL THERAPY / PHYSICAL THERAPY learning to ride a tricycle, she wished someone had reminded her,” he says. To further demonstrate the point a short video was shared emphasizing “it is perfectly fine and encouraged to help out a co- worker -- whether they are a therapist, supervisor, or any employee -- if a practice is unsafe.” • Safety Alerts use photos and ‘What Could Happen’ scenarios to warn staff of potential hazards and how to avoid them by implementing proper mitigation strategies. The alerts replace the previous method of sending emails (which could get lost in crowded in-boxes), and are easy-to-find in a central online location. Detailed safety inspections of the OT/PT/TR environment and equipment occur quarterly by rehab techs trained in spotting potential safety issues. Problems are escalated to the appropriate department (i.e., plant engineering or clinical engineering) for further assessment. • Staff is encouraged to self-report all patient- or employee-related safety events or concerns by calling the hospital’s designated phone line. • Adivision-wideDailySafetyBrief,modeledafterCincinnatiChildren’s Daily Operations Brief, is a five-minute phone call held each weekday that reports unexpected outcomes from OT/PT/TR representatives at 14 outpatient and inpatient locations. The intention is not to solve problems while on the call, explains Elizabeth, but to report and share unexpected outcomes. Further investigation and mitigation occurs CINCINNATI CHILDREN’S / OCCUPATIONAL & PHYSICAL THERAPIES Kathy Neff, PT (Physical Therapist)
  • 39. “We’ve learned that by focusing on precursor safety events and unexpected outcomes, we’ve been able to significantly reduce serious safety events from occurring.” PAGE 39 after the call by the moderator, generally a member of the Safety Domain. On average, eight unexpected outcomes are reported each day. WhenAnitaDrabouskyMBA,OTR/LfirstsuggestedaDailySafetyBrief, she was met with some pushback from staff who wondered ‘what will we have to talk about every day?’ But it didn’t take long for participants to realize the value. “If something is happening at one location, there’s a good chance it also is happening at other locations. The Daily Safety Brief puts us all on alert to potential safety issues,” explains Anita. The division continues to work on using safety data to predict and more quickly respond to trends by increasing reporting and creating a safety matrix. The matrix includes data from both patient and employee safety reports which plots: 1) what types of safety issues are occurring, 2) with what frequency, and 3) the severity of each. The goal is to get ahead of safety risks before they occur. The transformation within the Division is a clear indicator that efforts to establish a culture of safety are making a difference. “We’ve learned that by focusing on precursor safety events and unexpected outcomes, we’ve been able to significantly reduce serious safety events from occurring,” explains Becky Reder OTD, OTR/L, Senior Clinical Director, Therapy Services. Tommy Evans AuD Audiologist Northern Kentucky Neighborhood “I help make Cincinnati Children’s a Destination of Excellence for our patients and families by… providing quality hearing healthcare services that are not only collaborative and innovative, but most importantly, fun for the children we evaluate and treat.” Name Occupation Location OCCUPATIONAL THERAPY / PHYSICAL THERAPY P A S S P O R T CINCINNATI CHILDREN’S / OCCUPATIONAL & PHYSICAL THERAPIES Annie Jennett, PT (Physical Therapist)
  • 40. PAGE 40 Antimicrobial Stewardship Program Each year millions of lives around the world are saved by the use of antibiotics. With this widespread use, however, comes the risk of multi-drug resistant bacteria and a serious threat to the efficacy of those antibiotics. The Antimicrobial Stewardship Program at Cincinnati Children’s was formed to address this threat and improve the safety of patients, a goal that is already seeing promising results. Founded in 2013 as a partnership between the Divisions of Pharmacy and Infectious Disease, the program seeks to impact all areas of the hospital and its patients by reducing harm associated with antibiotics. Clinical pharmacist Dr. Joshua Courter explained that the drugs are unique in the way their use, or misuse, affects the population. “Antibiotics are one of the only things in the world where how you give it to one patient will affect how it works in the next patient,” says Courter. “Because you can actually cause resistant organisms, and those can spread to other people, it makes it a community problem.” By reducing the amount of incorrect or inappropriate antibiotic use and switching patients to narrower, more active antibiotics, the program hopes to reduce the threat of drug-resistant bacteria throughout the hospital and community.AtargetedeffortwiththeBoneMarrowTransplantdivision,for example, has reduced the use of the broad-spectrum antibiotic meropenem by 43% in that population. Each day, the Antimicrobial Stewardship Program tracks the use of specific antibiotics like meropenem throughout the hospital. The data is then reviewed for insight into possible changes and improvements. With a nationwide focus on reducing multi-drug resistant bacteria, this program has contributed to reductions in negative side effects from drugs that can be replaced with other effective options at significant cost savings. Working together with the Medication Use Value Team, the Antimicrobial Stewardship team was able to add an additional antifungal medication option with equivalent safety and effectiveness. The switch to this medication alone will result in an estimated $60,000 per year savings for the institution. This process team was awarded the 2014 Award for Excellence in Teamwork in Quality Improvement, from the Society of Hospital Medicine for their role in shortening antibiotic treatment duration for skin and soft tissue infections and improving antibiotic prescribing in childhood pneumonia. CINCINNATI CHILDREN’S / PHARMACY

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