Pioneer Award Projects
Enhancing Patient Care with Post Operative Phone Calls
Carilion Clinic Neurosurgery
Before January 2013 Carilion Clinic Neurosurgery received regular feedback from patients who were confused on where to seek advice and support for peri-operative needs.
Nursing staff implemented post-operative phone calls, reaching 642 out of 808 eligible patients between January and June 2013. Patients who received the calls showed significantly less confusion regarding peri-operating concerns.
After implementing and analyzing the process, the team started pulling an Epic surgical report twice per week rather than once per week, added two urgent slots to all provider clinic schedules, added a post-operative questionnaire in Epic and began monthly audits and data collection.
The process has prevented 18 patients from going to the ED, among other benefits. General Surgery has also adopted the process.
Brook Cannon, R.N.
Wanita Cox, R.N.
Sherry Govin, R.N.
Anna Loflin, R.N.
Brenda Pagluica-Murray, R.N.
Kinsey Runion, R.N.
Darla Summers, R.N., team leader
Lindsey Woods, R.N.
Implementation of the Neotech RAM Cannula in the PICU
Carilion Clinic Children’s Hospital – Respiratory _ erapy
The Non-Invasive Ventilation Interfaces (NIV) on the market were uncomfortable, ill fitting and time intensive for hospital caregivers in the Pediatric ICU.
Once NIV fails, the patient is intubated and there is an increased incidence in VAP, possibility for secondary infection and increased length of stay. The solution for a non-invasive and non-traumatic Neotech RAM Cannula was adopted.
For those patients meeting specific inclusion criteria, the percentage of patients needing intubation reduced from 7% in 2012 to 3% in 2013. Moreover, the Neotech RAM Cannula does not require a seal, can deliver CPAP, PPV, IMV and continuous oxygen.
Thomas Kayrouz, M.D.
Shari A. Toomey, team leader
Improving Patient Safety by Ensuring Clear Medication Orders
Carilion Medical Center
A March 2012 The Joint Commission review at CRMH found an unacceptable number of medication orders without clear administration parameters.
The Accreditation Readiness and Pharmacy departments teamed to identify the root cause and implement solutions. A random sample in June 2012 found only 172 out of 259 orders (66%) to be compliant: root causes were lack of communication, incorrect EMR use, poor grasp of complete medication orders and incomplete administration instructions on certain order sets. Similar issues were found at CNRV and CGCH.
The team worked with physicians to update the order sets. The medication audit tool was also updated. These changes were reinforced through staff education, timely audit results and continuing order set reviews.
CRMH achieved 91% compliance in October 2012, a 25% increase. CNRV and CGCH showed similar improvements.
Terri Fritz, team leader
Yoonseon (Sunny) Kook, R.N.
Larry Mullins, team leader
Improving Patient Satisfaction
Carilion Roanoke Community Hospital
Carilion Roanoke Community Hospital (CRCH) Outpatient Surgery and Endoscopy recorded poor HCAHPS scores in communication and pain management in FY2011. Setting a goal to achieve top-tier scores, the staff team reviewed FY11 data. The root cause was that the units had no standard way of communicating with patients.
A patient satisfaction team began meeting monthly in June 2012 to review scores and identify fixes. The team developed a patient welcome letter using scripting as well as a communication checklist to follow the patient through the entire visit; the tools were implemented in August 2012 after two rounds of staff education.
The improvements resulted in CRCH Outpatient Surgery and Endoscopy both receiving 5 Star National Quality Awards in June 2013, HCAHPS scores having increased from 75% to 95% since FY2011.
Nena Barnett, R.N.
Vicky Beckner, R.N.
Jeanne Cason, R.N., team leader
Diane Cochran, R.N.
Debbie Copening, R.N.
Sue Corrigan, R.N.
Sarah Goad, R.N.
Penny Green, R.N.
Cindy Hodges, R.N.
Diane Lewis, R.N.
Nicole Lovell, R.N.
Laura Nelson, R.N.
Katie Poindexter, R.N.
Jane Young, R.N.
Carilion Medical Center
Despite clinical evidence showing changes in patient vital signs up to 8 hours before a serious cardiac or respiratory event, CRMH nurses frequently lacked early recognition of patient decline outside the ICU.
Data was gathered on the number of Code Blues across each unit at CRMH between January and May 2012: four PCUs had 15 of the 35 Code Blues.
Key problems identified included lack of early recognition, lack of Rapid Response Team initiation, lack of communication to providers and lack of early intervention to mitigate further decline.
Starting in January 2013, high risk patients were targeted for additional assessments by expert nurses. This high risk target group was reviewed daily by a researcher.
Results have shown a statistically significant reduction in Code Blues for the four PCUs, along with increases in Rapid Response Team utilization and inpatient upgrades.
Alexis Andrews, R.N.
Brandie Bailey, R.N.
Barbara Boggs, R.N.
Joe Cannon, R.N.
Rick Gaylor, R.N.
Andrew Green, R.N.
Terri Gregory, R.N.
Alana Hall, R.N.
Patrick Hanner, R.N.
Jason Harrington, R.N.
Tammy Kemp, R.N.,
Kathy Ott, R.N.
Brian Philips, R.N.
Karyn Reese, R.N.
Kathy Shanz, R.N.
Robert Woodson, R.N.
Say No to Pneumonia:
Improving Pneumococcal Vaccination Rates in a Pre-surgical Testing Setting
Carilion Medical Center – Presurgical Testing
Centers for Disease Control recommend that 90% of individuals over 65 with chronic diseases and/or smokers receive pneumococcal vaccine. Research indicates that patients hospitalized with pneumonia who had prior pneumococcal immunizations had about a 40% lower rate of mortality than those not immunized.
Outpatient encounters provide an excellent opportunity to immunize. Patients are screened in the pre-surgical testing setting, according to CDC guidelines, but only 24%, or 1,368 patients, of those who met the criteria were being immunized.
With the implementation of staff education and regular feedback, reinforced and recognized achievement, in addition to a third grade reading level patient education message, the team was able to show positive improvement.
From January to June 2013 there was an increase of 20% in pneumococcal vaccination rates compared with the same period 2012; from 20.18 to 40.11%. In June, 503 patients have received the pneumococcal vaccine, reaching over 50% of eligible patients.
Rebecca Clark, Ph.D
Paul Eastbrooks, Ph.D
Brenda Gilliam, R.N.
Deborah Hodges, R.N.
Julie Jackson, R.N., team leader
Presurgical Testing Team
The Clean Team
Carilion Roanoke Memorial Hospital
Environmental Services quarterly Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) cleanliness score from October 2012 to December 2012 was 59.37%, or well below the national average. In tandem, there were inconsistencies in discharge room cleaning times and increased admitting patient wait times.
Through the hard work and implementation of a High Touch Surface Monitoring Program, Cart Program, Delta Team and staffing optimization, Environmental Services has been consistently increasing the HCAHPS score to 76.45% in the third quarter of 2013.
VTE Prophylaxis on Time
Venous Thromboembolism (VTE) is a condition that includes deep vein thrombosis and pulmonary embolism. It is recommended that surgery patients should receive appropriate VTE prophylaxis within 24 hours before surgery to 24 hours after surgery.
This was a problem at Stonewall when the compliance rate for surgical patients dropped to 50% and 60% for January to February 2013, respectively.
An interdisciplinary team determined the root causes in failure and initiated primary efforts to improve and maintain appropriate VTE prophylaxis compliance to 100% for all surgical patients undergoing colon, hip or knee surgery per best practice guidelines.
By educating PACU staff, pharmacists and medical/surgical floor nurses on VTE orders in addition to completing a paper check list, compliance returned to 100% in May 2013.
Marlene Cooper, R.N.
Vicki Langdon, R.N.
Karen Zollman, R.N., team leader
“Time-Out” to Save 9 Lives
Carilion New River Valley Medical Center
One organ donor can save the lives of nine transplant recipients.
Carilion New River Valley Medical Center was inconsistently contacting LifeNet Health on ventilated patients who met referral for possible organ donation criteria prior to extubation: 80% compliance July – September 2012 and 60% compliance October – December 2012.
After attending LifeNet Conferences and implementing a “Time-Out” Epic optimization, referral compliance returned to 100% in January 2013. All critical care nurses and respiratory therapists are using a new “Time-Out” process in Epic to ensure the correct patient is identified and the reason for extubation is noted. If extubation is identified as end of life, the nurse ensures that LifeNet Health has been notified.
Desiree Beasley, R.N.,Team leader