This document provides an overview and outcomes report from the nursing department of Abbott Northwestern Hospital for 2008. It includes a letter from the Vice President of Patient Care Services introducing the report and highlighting the outstanding work of the nurses. It also outlines the hospital's nursing vision, core beliefs, and professional nursing practice model. Examples are given of initiatives to promote evidence-based practice, improve documentation, enhance care delivery through interdisciplinary collaboration, and achieve Magnet designation, recognizing nursing excellence.

1. nursing department
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2. Nursing Department
Overview and Outcomes Report 2008
Table of Contents
1 Letter from the Vice President of Patient Care Services
2 Vision/Core Beliefs
3 Professional Nursing Practice Model
23 Celebrating Excellence, Innovation and Advanced Learning
34 About Abbott Northwestern Hospital

3. Overview
Letter from the Vice President of Patient Care Services
it is my pleasure to present the 2008 abbott Allina nurses are the
northwestern nursing department annual Outcomes embodiment of the art and
report. the features, outcomes and recognition presented science of caring. Every day,
here are a snapshot of the outstanding work nurses are more than 5,200 nurses
across the organization use
doing every day.
their expertise and passion
to advocate and provide
abbott northwestern nurses comprise nearly half of
care for patients, while
allina Hospitals’ & clinics’ nursing workforce. as elevating the standards
a magnet™-designated hospital and leaders in this of exceptional nursing
organization, the bar on our standards of excellence practice.
continues to rise. Our mission, vision core beliefs and
professional nursing practice model are the foundations
that have poised us to meet and exceed these standards.
terry Graner, rn, ms, nea-Bc
vice president, patient care services
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4. Vision/Core Beliefs
Allina’s Mission Allina’s Nursing Vision
We serve our communities • Allina will be nationally known and trusted for exceptional
by providing exceptional nursing practice.
care, as we prevent illness, • Allina nurses combine the best of science and caring
restore health and provide to provide exceptional patient care through trusted
partnerships and effective stewardship.
comfort to all who entrust
• Allina’s healing environment fosters nursing practice that
us with their care. is evidence-based, innovative, and patient/family centered.
• Allina nurses are powerful, passionate and diverse in talents
and thought.
• Nursing career paths provide Allina nurses with dynamic
opportunities for career enhancement to help them achieve
their highest potential.
• Nursing leadership is relationship-centered, holistic,
progressive, and responsive.
Nursing Core Beliefs
• Advocacy
• Caring
• Continuous Improvement
• Cultural Awareness and Recognition
• Ethics
• Leadership
• Relationships
• Stewardship
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5. professional nursing practice model
Built on the foundations of the Outcomes
individual relationships nurses
establish with patients and s Ou
me tc
families, the Professional Nursing
o
om
Systems Interdisciplinary
tc
Practice Model incorporates all
Ou
Support Relationships
e s
of the components necessary
for the delivery of exceptional
nursing care. Vision/
Leadership
Core Beliefs Patient- Coordination
Centered of Care
Outcomes
Outcomes
the diagram of the professional
nursing practice model is designed patient
to provide a visual representation & Family
of the fundamental components of
Clinical
nursing practice that are defined in Standards Caring Competence Research/
the allina charter for professional of Practice/ Evidence-Based
Dimensions Practice
nursing practice. the model is meant
to demonstrate all of the things nurses
inherently know as part of their
s
Ou
Professional
e
professional practice.
om
Professional Nursing
tc
o
Development
tc Collaborative
me
Ou Governance
s
Outcomes
Research/
Evidence-Based
PROf E S SIONA L N u RSI Ng PR AC t IC E MOdEL
Practice
Research/Evidence-
Based Practice –
Evidence-Based Practice
Fellowship teaches nurses to
question
it is one thing to discover through
research. it is another to apply research
to clinical practice.
that is what is behind the evidence-
Based practice Fellowship at abbott
northwestern Hospital. the Fellowship
provides staff nurses with classroom
instruction and mentoring to investigate
clinical questions and integrate their
findings into nursing practice.
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6. Sendlebach also says that the the development of evidence-based sendlebach also says that the
Fellowship has a domino effect. practice. clinical nurse specialists act Fellowship has a domino effect.
as mentors, helping nurses translate “nurses who have participated in the
“Nurses who have participated research findings into practice. Fellowship share with their colleagues,
in the Fellowship share and colleagues see that it works.”
with their colleagues, and By giving nurses time each month
colleagues see that it works.” within their work agreement to focus the value of involving staff nurses in
on a clinical question, the Fellowship evidence-based practice is that there
also helps to address one of the is often immediate relevance in their
challenges that the profession faces work. “working at the bedside results
Launched in 2008, the Fellowship is a in emphasizing evidence-based care. in unique questions and insights,”
12-month program that partners a staff “nurses are so busy – it’s impossible to said sendelbach. “i can help nurses
nurse with a clinical nurse specialist to add time for this kind of work within understand what the literature shows,
address a nursing practice question. it the work day,” said sendelbach. but i don’t implement practice changes.
was created by sue sendelbach, phd, it’s really much more challenging to
rn, clinical nurse researcher and clinical sendelbach believes that the think about how to change practice.”
nurse specialist, with her colleagues, Fellowship makes nurses think
Kathi Koehn, rn, staff nurse, and differently about many aspects of
terry Graner, ms, rn, nea-Bc, vice nursing practice, raising their awareness
president of patient care services, as a of the importance of evidence-based
way to introduce evidence-based practice practice and ways to incorporate it in
to the nursing staff. their work. “i’ve had nurses tell me that
this inspires them to go to the literature
the Fellowship teaches participants how much more frequently, not only to
to analyze research literature and use it address situations they face at work,
as a tool to solve clinical questions. it but also in their personal health,” said
also encourages them to use their own sendelbach.
experience and knowledge to guide
Evidence-based Practice Fellows
2008-09
Fellow Mentor topic
Meghan Davitt, E3100/W3500 Sue Sendelbach Care of patients wearing graduated compression stockings
Laura Genzler, PB2000 Sarah Pangarakis Clustering of nursing activities and end tidal CO2
Linda Isenberg, W6300 Sandy Hoffman Parental involvement following a mother’s C-section
Geraldine Sjoblom, H4100 CV-ICU Sue Sendelbach Care of critically ill patients experiencing ETOH withdrawal
2009-10
Fellow Mentor topic
Laura Genzler (continuing) Same as above Same as above
Damon Gates , H4200 CV-ICU Anita Anthony Interventions to prevent falls of hospitalized patients
Jolene Laurence, SK4800/3900 Sue Sendelbach Weighted blankets and their impact on sleep
Brad Lind, H5000 Sue Sendelbach Interventions for spiritual care
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7. Systems
Support PROf E S SIONA L N u RSI Ng PR AC t IC E MOdEL
Systems Support
Consistent stroke education
improves documentation
applying care standards consistently
among patients with similar needs is a
hallmark of effective patient care. the
challenge for nurses is incorporating such
standards into their workflow as they
manage a multitude of patient care tasks.
On H8000, excellian (the clinical
documentation system) has been
enhanced to better support nurses
in meeting a key quality standard:
providing documented education to a stroke team revised existing patient
stroke patients to help reduce the education tools and incorporated them
risk of a recurrent stroke or transient into excellian. nurses were educated
ischemic attack. about the required elements and
Completion of All Post-Stroke
the stroke team also used excellian
Education Criteria
the american stroke association, to provide staff alerts about needed
Joint commission and centers for education documentation. 80%
disease control and prevention jointly 70%
identified five topics that all stroke documentation of all five stroke 60%
patients should be educated on during education elements increased to 50%
Rate
hospitalization. these are: 76 percent in the second half of 2008. 40%
30%
• modifiable risk factors
“excellian gives us a process check,” 20%
• warning signs
said Gordon mcarthur, H8000 patient 10%
• accessing emergency care if care manager. not only does it provide 0%
symptoms occur Jan-June July-Dec 2
tools to track each patient’s learning 2009 009
• follow-up care after discharge progress, it helps nurses tailor education
to the patient’s needs. “part of the
• medications prescribed at discharge. All five patient
process includes a learning assessment, education elements
so nurses know how a patient learns documented
in the first half of 2008, an audit
best and what barriers might exist, such
of both nursing and physician
as cognitive status or language.”
documentation revealed that all five
elements were documented only 59
it’s also useful for auditing. “it tells us
percent of the time. Further analysis
exactly how we are doing in meeting
showed that
the standard and helps us prioritize
• it was primarily as issue of which areas we need to focus on for
documentation, rather than a lack of improvement,” said mcarthur.
patient education
• Excellian could be enhanced to
simplify and facilitate documentation
of stroke patient education
• nurses were not fully aware of the
required education elements.
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8. Interdisciplinary
Relationships PROf E S SIONA L N u RSI Ng PR AC t IC E MOdEL
Interdisciplinary anita anthony, rn, ms, ccrn-cnc, that when the therapy is used with
cns-Bc, a cardiovascular clinical patients who have other co-morbidities,
Relationships nurse specialist who helped lead the the outcomes are not as good,” said
New therapy brings heart aquapheresis work group. anthony.
failure care providers
in august 2008, the treatment was made But many other individualized decisions
together available on H400, a cardiovascular are required to ensure that the therapy
thanks to the work of a multidisciplinary telemetry unit. the work group believed is used safely and effectively with each
work group, a treatment for fluid overload that expanding the use of aquapheresis patient. that’s where the huddle concept
in chronic heart failure patients, is on the telemetry units would make comes in.
being used more effectively at abbott it readily available to the type of
northwestern. patients who could most benefit from Key disciplines, including nursing,
it, including pre-transplant patients and leadership, cardiology, pharmacy and iv
the treatment, called aquapheresis, patients with chronic heart failure. they nursing, gather before therapy is initiated
removes excess fluid through placement also wanted to improve the effectiveness to determine the appropriate iv access,
of an intravenous (iv) catheter. the of the therapy, which requires careful anticoagulation therapy, fluid removal rate
therapy gently pulls blood through a monitoring of anticoagulant therapy and treatment goal.
circuit that filters out water and sodium and renal function while ensuring that
and returns the blood to the patient. a clot doesn’t form in the circuit. “if a since initiating the huddle for
clot begins to form, nurses have about aquapheresis in august 2008, the therapy
among the work group’s recommendations 10 minutes to troubleshoot the problem,” has been used 24 times, including 12 in
was to implement the huddle concept said anthony. if the filter does clot, the icu and 12 in the telemetry unit.
when initiating the therapy. the the therapy must be stopped before the circuit use per patient has decreased
huddle concept brings together a varied treatment goal is achieved, or the circuit from 2.19 to 1.3, while treatment times
team of professionals who support and must be replaced—at a significant cost. increased from 45 hours to 49 hours.
complement each other’s skills in order “the longer the
to make decisions about a patient’s care. a first step was patient can be treated
identifying the right Thanks to the work of a on one circuit, the
although aquapheresis was developed kind of patient for multidisciplinary work more cost-effective it
as a non-intensive care unit (icu) the therapy, an issue group, a treatment for fluid is, and the more likely
therapy, abbott northwestern had used that the equipment overload in chronic heart it is that the treatment
it exclusively in the cardiovascular manufacturer helped goal will be achieved,”
the team address.
failure patients, is being said anthony. abbott
icus. “Often, we had to transfer patients
to the icu just to get the therapy,” said “we’ve learned used more effectively at northwestern’s
Abbott Northwestern. aquapheresis treatment
time now exceeds
the national average,
which is 46 hours.
“this interdisciplinary work has
improved the effectiveness of
aquapheresis in the icu and in the
telemetry units,” said catherine Houda,
ms, Bsn, rn, ne-Bc, patient care
manager of H4000. “it’s also bonded the
staff from each unit as they learned from
each other how to best manage patients
receiving the therapy.”
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9. Leadership
PROf E S SIONA L N u RSI Ng PR AC t IC E MOdEL
Leadership
Magnet™ designation—
a journey to success
although it was called the magnet
journey, the 2008 effort that led
to abbott northwestern’s magnet
accreditation might well be described
as an all-out mobilization.
tonya montesinos, director of
professional nursing practice
and magnet coordinator, led the
charge, involving nurses in all job
classifications and specialties to
assemble the mammoth documentation
and prepare for the onsite survey
required for accreditation. dedication to the success of the project moreover, montesinos and tucker
started at the top with terry Graner, say that the process of documenting
she was assisted by dawn tucker, vice president of patient care services, nursing excellence allowed nurses to
marketing and communications who wrote major sections of the report step back from their day-to-day practice
consultant. together (and with and helped montesinos and tucker and see their work in a new light. “this
significant help from many nursing track down the people, data and stories really gave nurses a chance to look at
colleagues) they planned, researched, their work in-depth,” said tucker. “it
wrote, verified, edited and assembled made them stop to recognize and be
the 2,000-page application document,
“This really gave nurses a recognized for the amazing things they
a process requiring countless hours in chance to look at their work do every day. it also created a deeper
their designated “war room.” in-depth,” said Tucker. “It awareness of the excellence happening
in every corner of the hospital.”
made them stop to recognize
For tucker, just thinking about the size
and be recognized for the the process also demonstrated
of the project was overwhelming. “You
had to figure out how to section off the amazing things they do every to montesinos the importance of
work. if you got stuck, you needed to day. It also created a deeper leadership and commitment in
move on and come back to it later.” awareness of the excellence accomplishing any goal. Good
planning, attention to detail and
happening in every corner of follow-up, communication, flexibility
But the volume of work leading to
magnet accreditation is only part of the hospital.” and perseverance helped to transform
the story. it was eclipsed by the energy the project into an organizational
and enthusiasm generated among milestone. “For myself, the motivation
nurses and their non-nursing colleagues that would help document the nursing was obtaining this international
throughout the hospital. department’s accomplishments. recognition for the nurses. Our nurses
deserved this honor and that’s what
“we were successful because everyone credit also goes to many other kept me going,” she said.
wanted this award,” said montesinos. contributors. “it was phenomenal. at
“it wasn’t just us in the war room. it the end, we had so many people calling “tonya has a no-fail clause in
was everyone pitching in together. this us with examples and stories to include everything she does—it was never in
came together because nobody said no.” in the documentation. You could feel her mind that abbott northwestern
the energy and pride in every story that was not going to get magnet
was shared,” said montesinos. accreditation,” said tucker. “You can’t
ask for better leadership than that.”
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10. Professional
Nursing
Collaborative PROf E S SIONA L N u RSI Ng PR AC t IC E MOdEL
Governance
Professional Nursing when patient/visitor safety report data the new process involves calling a
showed errors with endoscopy specimen hard stop at the end of the endoscopy
Collaborative labeling and handling, the endoscopy procedure to:
Governance council implemented a new “hard stop”
process and shared accountability for
• re-verify the patient’s name and
medical record number
Change begins at the bedside specimen handling with physicians.
• verify that label information
there is a simple premise behind correctly identifies the specimen
“we were averaging about one or two
collaborative governance: change and confirm the accuracy of other
incidents a month in which a specimen
happens from within. information on the specimen label
wasn’t identified correctly or the
labeling was incorrect or the specimen • have the physician sign the
that’s because the people who are best
was missing,” said diana nissen, center histopathology form.
able to plan and implement a change
for advanced endoscopy patient care
are those who are most affected by it.
manager. the number of errors has dropped
significantly since the process was
at abbott northwestern, collaborative
endoscopy nurses collaborated with implemented in the first quarter of
governance begins with local councils
surgical services on the process, 2009. there were 10 errors during
organized around patient care communities
sharing ideas for process improvement. 2008. in the first quarter of 2009, there
that are empowered to make changes
the council also sought endorsement were two errors, and there have been
to improve practice, education, quality
and support from the endoscopy no errors since march 2009.
and research. the councils have links
medical staff committee.
to hospital-wide nursing governance
“when you’re in management, you
through representation on the nurse
the endoscopy council focused on ways need that connection to reality that
practice council.
to accomplish safety objectives without the direct patient care nurse has,” said
adding too many steps to the workflow. nissen. “i can provide the data that
a recent process change enacted by
“that’s where it’s really important to tells what’s wrong, but they are much
the endoscopy council illustrates how
have input of the people who do the better at identifying how to fix it.”
collaboration among different care
work,” said nissen.
communities and disciplines can improve
patient care.
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11. Professional
Development PROf E S SIONA L N u RSI Ng PR AC t IC E MOdEL
Professional in 2007, Blake joined an interdisciplinary showed how room set-up and cord
team of nurses and physicians who entanglement could impede an
Development completed simulation training at emergency patient transfer.
Simulation training helps the stanford school of medicine’s
center for advanced pediatric and But she has found that simulation
create a better reality
perinatal education (cape) program. training is particularly useful in
when Barbara Blake, rnc-OB, started state-of-the-art simulation equipment enhancing critical thinking skills,
her nursing career, obstetrical nursing was acquired in 2008 and has allowed teamwork and communication.
had an immediate appeal. “i jumped abbott northwestern to develop one of participants learn the importance of
into Labor and Delivery nursing and the only simulation programs of its kind voicing their concerns or observations
have remained in this area for most of in the region. out loud and how to do so productively.
my career,” she said. she has worked at “it also helps you see how your behavior
abbott northwestern’s Birth center for Led by Birth Center educators Jone affects care. it really opens your eyes,”
22 years. tiffany, ms, rnc-OB, and Katie said Blake.
molitor, rnc-OB, the team has
But recently she has had the opportunity created a variety of lifelike scenarios to in addition, many of the lessons learned
to apply her knowledge and experience in help train for situations like shoulder in simulation training can be applied
a new way—by learning to use simulation dystocia, emergency cesarean sections, to a variety of patient care situations.
training to help colleagues better prepare newborn resuscitation, anesthesia “nursing has always been focused on
for obstetrical emergencies. emergencies and more. tasks and skills, but this is developing
much more than that,” said molitor.
in doing so, she has not only found a simulation training includes a pre- “it encourages people to look at their
new avenue for her own professional briefing, the videotaped exercise and a behaviors and communication style.
growth—she is helping others de-briefing. “most of the learning takes this really gets at the art of nursing.”
enhance their skills and improve their place in the de-briefing,” said molitor.
effectiveness in a variety of patient care that is where participants review
situations. “this felt like a natural step the videotape, leading to insights
at this point in my career,” said Blake. about system failures, communication
“it was nice to feel that i was valued breakdown and behavioral issues.
enough to be given this opportunity.” For example, Blake said that simulation
Simulation training includes a
training highlighted the need for a
single phone call alert to the entire pre-briefing, the videotaped
emergency c-section team. it also exercise and a de-briefing.
“Most of the learning takes
place in the de-briefing,”
said Molitor. That is where
participants review the
videotape, leading to insights
about system failures,
communication breakdown
and behavioral issues.
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12. Stamdards
of Practice/
Dimensions PROf E S SIONA L N u RSI Ng PR AC t IC E MOdEL
Standards of Practice/ tomography (ct) contrast dye and supporting materials, including laminated
can be flushed with saline instead of instruction cards, were distributed. then
Dimensions— heparin. with growing awareness of they took time to do rounds on patient
Elevating nursing standards, the danger and prevalence of heparin care units and demonstrate the technique
allergies, the team felt it would offer for available staff.
one PICC line at a time
clear benefits to patients.
Olson also used a simple demonstration
the word static simply doesn’t apply But soon after introducing the catheters, with blue dye in a clear catheter that
to nursing. the team began receiving reports of clots showed how blood could reflux into the
in the lines and increased use of tissue end of the catheter if the flushing wasn’t
practice standards, technology, procedures plasminogen activator (tpa) to clear the done properly. Blood in the catheter can
and medications are in constant flux and clots. similar reports surfaced at other lead to a clot. “it’s one thing to talk about
it’s up to nursing specialists to ensure that hospitals using the catheters, including a new procedure, but sometimes if you
as patient care evolves, it does so safely, other allina hospitals. don’t see it, it doesn’t click,” said Olson.
effectively and efficiently.
Olson and others immediately began “we felt that this was the best vascular
the intravenous (iv) team is one investigating the situation and contacted device to use because it didn’t require
such group of nursing specialists. the manufacturer for assistance. initially, heparin—but we also needed to do all we
“this is an engaged group,” said Jenny it was believed that changing the cap could to make it user friendly,” said Olson.
enstad, patient care manager. “they do used on the device would help, but
research on their own and bring it to my problems still occurred. it became since the flushing procedure was clarified
attention. they have a focused role that clear that nurses needed to learn a new in mid-2008, the number of picc line
is constantly evolving.” flushing procedure to prevent clotting. clots has come down. Olson and others
continue to work with the manufacturer
in 2008, the iv team began using a working with the picc and cap to determine if design changes could
new generation of peripherally inserted manufacturers to clarify the proper help to further reduce the problem.
central catheters (picc). according to technique, iv team representatives went
carol Olson, rn-Bc, the new catheter to local nurse practice councils throughout “this kind of clinical leadership is critical
allows for power injection of computed the hospital to teach the flushing protocol. to good nursing care,” said enstad.
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13. Remaining Standards protocol for at-risk patients. By the end WomenCare Community
of 2008, the number of pressure ulcers improving care for patients who are
of Practice/Dimensions had decreased from 30 percent in the Morbidly obese During pregnancy
first quarter of 2008 to zero percent in patients who are morbidly obese during
Cardiovascular Community the fourth quarter of 2008. pregnancy are at a significant risk for
reducing Heart Failure readmissions medical and obstetric complications.
improving the critical care a multi-disciplinary team is working
Heart failure is the most common
orientation process to improve quality of care and safety
discharge diagnosis in center for
the critical care design team was for these patients while providing
medicare services (cms) patients and
formed as a collaborative effort to compassionate care. patients are referred
is a leading cause of hospitalization,
standardize and enhance the critical to an obstetric care coordinator who
re-hospitalization and clinic visits.
care orientation process for H4100, works with the clinical nurse specialist
the cardiovascular community
H4200, pB2000, post-anesthesia to develop an individualized plan of
significantly reduced heart failure
care unit and critical care Float care. this addresses any specialized
readmissions (for any cause) within
pool. in 2008, the team implemented needs related to hospitalization, labor,
30 days, achieving a 16.2 percent
a centralized critical care orientation surgery and post-partum care. the
readmission rate for fourth quarter.
calendar. it includes standardized care coordinators arrange for specialty
this is a 23 percent reduction from
introductory and closure days for consultation as needed, and patients
the 2006 baseline rate. a variety of
all orientees (while maintaining a complete an activities of daily living
strategies contributed to the reduction,
station-specific component), a single assessment to help identify needs related
including nurse follow-up phone calls
critical care orientation book and to mobility, sleep apnea and personal
within 24-48 hours, one-time home
folder, streamlined and standardized care. an obstetric/bariatric equipment
nurse visits for high risk patients who
learning packets and a variety of other and supply cart is being developed to
did not qualify for home care, a care
tools and support materials. it also ensure easy access to items that are
management pilot, and advanced care
incorporates the essentials of critical essential for the care of these patients.
planning sessions for heart failure
care Orientation (eccO) online
patients through palliative care.
program and classes, simulation training,
float days and clinical shifts. this has
reducing Hospital-Acquired
resulted in a more efficient and effective
pressure Ulcer incidence
orientation process and has created many
the incidence of pressure ulcers is a key
opportunities for the various critical
nursing quality indicator. in spring 2008,
care teams to learn from each other.
the pressure ulcer incidence rate peaked
on H4200 cardiovascular medical
intensive care. the pressure ulcers were
related to equipment used to secure the
patients’ airways. a multi-disciplinary
team addressed the problem by changing The Cardiovascular Community significantly
endo-tracheal products, educating the
reduced heart failure readmissions (for any
staff about the use of tubes and plates
against the skin, reviewing and updating cause) within 30 days, achieving a 16.2 percent
procedures related to the care of the readmission rate for fourth quarter.
intubated patient, emphasizing the
nursing skin assessment upon admission,
initiating weekly skin rounds and
piloting a medical nutrition therapy
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14. Critical Care Community (PB2000, H4100,
H4200)
reducing the incidence of Ventilator-Assisted
pneumonia (VAp) through increased nursing Oral Care Adherence
Adherence to oral care protocol PB2000
the american association of critical-care nursing 140%
(aacn)has established an evidence-based protocol 120%
120% 112%
for providing oral care to the critically ill patient.
Q4hr Adherence Rate
96%
while all patients should received oral care based on 100% 86%
the protocol, ventilated patients are of special concern 80%
because mechanical ventilation can contribute to
60%
mucositis and gram negative bacteria colonization,
placing them at risk for vap. the protocol recommends 40%
brushing every 12 hours and swabbing and suctioning of 20%
the oral pharynx every 2-4 hours.
0%
Sept 07 Oct 07 Mar 08 Apr 08
an oral care initiative was piloted on pB2000 in
march-april 2008. results were compared with
pre-implementation data gathered in september-
October 2007.
results
during the pB2000 pilot, adherence to the protocol: Oral Care Adherence
Critical Care Units
• increased by 25 percent for the minimum 140%
124% 123% 125%
recommendation of oral care every four hours
120% 112%
102% 104%
• increased by 12 percent for the optimum 100%
Q4hr Adherence Rate
100% 92%
recommendation of oral care every two hours.
80%
63%
vap occurrence during the pB2000 pilot was 0/1,000 60% 49%
ventilator days, compared to 1/1,000 ventilator days
40%
during pre-implementation.
20%
in fourth quarter 2008, the oral care initiative was 0%
implemented in all three intensive care units (pB2000, PB2000 H4200 H4100
H4100, H4200). By the end of 2008, adherence to Critical Care Unit
the protocol at three-hour intervals had increased in
all three units (see chart). also, H4100 and H4200
Baseline Oct 08 Nov 08 Dec 08
sustained 0 vap from may to dec 2008 while pB 2000
maintained a vap rate of 0.8 compared to national
benchmark of 3.1 for like units. Note: Adherence Rate = The times of acutal clearnings divided
by times of predicated cleanings
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15. Spine Institute – H7000 Orthopaedics Community – H7200/H8200
Using learning paths to improve creating a patient-centered experience
the orientation process in september 2008, abbott northwestern Hospital implemented the Joint replacement
with an increased volume of newly center, a multi-faceted program dedicated to care for joint replacement patients. it
hired nurses, the spine institute provides a patient-centered experience focusing on patient preparation and education
introduced the concept of learning (before and during hospitalization), innovative and proven surgical techniques, multi-
paths to improve the orientation modal pain control and an accelerated post-operative recovery program offering skilled
process for both preceptors and and compassionate care. patients are cared for on a dedicated floor by an experienced
orientees. Learning paths: staff and participate in group therapy. the Joint replacement center’s multidisciplinary
• help track an orientee’s progress team meets monthly to evaluate strategies to improve the care they deliver.
through the orientation process
since the center opened, discharges to home have more than doubled for patients with
• provide guidance to the
total hip replacement and almost tripled for those with total knee replacement. Length
preceptor on areas in which
of staff has decreased by two-thirds of a day for total hip replacement patients and half a
the orientee has demonstrated
day for total knee replacement patients.
competency
• identify areas of needed
Total Knee Replacement Patient
development sooner in the
Discharge Disposition
orientation process
50% 46.9%
• assist the charge nurse in making 42.4%
Non-JRC Patients
assignments that are appropriate
40% 34.8% Jan 08-Mar 09
for the orientee 32.9%
Percentage of Patients
JRC Patients
• help preceptors keep each 30%
23.7% Sep 08-Mar 09
other informed about an
20%
orientee’s progress. 14.6%
10%
3.5%
results 1.1% 0.3%
0%
Learning paths were introduced 0%
Discharged to Discharged/ Discharged/ Discharged/ Expired
in July 2008. in 2007, 16 nurses home or self transferred transferred to transferred
spent an average of 41 shifts in care (routine to home skilled nursing to inpatient
discharge) under care of facility rehabilitation
orientation; in 2008, 16 nurses organized home facility (RF)
spent an average of 25 shifts in health service
organization
orientation.
Note: Non-JRC patients are those who received arthroplasty at Abbott Northwestern but were
not treated in the Joint Replacement Center.
Average Number of Shifts
Nurses Spent in Orientation
Medical/Surgical Community – E4100
50 Achieving recertification of transplant center
41 e4100 cares for post-operative patients who have received kidney transplants (from
40
both live donors and cadavers). the e4100 staff helped to assure recertification of
Number of Shifts
30 25 abbott northwestern’s Kidney transplantation program. this center for medicaid
services survey was in response to new federal regulations and affected all transplant
20 centers in the united states.
10
e4100 nurses receive annual education on caring for kidney transplant patients.
0 new employees are given additional education upon hire. the staff also works
2007 2008 closely with the Kidney transplant coordinators and the other members of the
interdisciplinary team to collaborate on the plan of care.
NuRSI Ng dE PA RtM E Nt 13

16. Surgical Services as a result, the number of patients whose temperature was >36˚c within 15 minutes
Maintaining normothermia in of leaving the Operating room increased significantly. data monitoring will
the perioperative Setting continue to ensure this improvement is sustained.
maintaining perioperative normothermia
improves patient outcomes. unplanned
hypothermia can result in impaired
wound healing, adverse cardiac events, Percent of Patients with a Temperature of >36˚C
increased risk of infection and prolonged Within 15 Minutes of OR Out Time
hospitalization. Main OR
100% 95%
preoperative, intraoperative and 92%
81% 83% 84%
postoperative nurses collaborated 80%
80%
with anesthesia providers to maintain
patient normothermia (>36˚c). steps 60%
taken included:
40%
• warming patients preoperatively
using a forced-air gown
20%
• warming the operating room for
patient arrival and wake-up 0%
2006 2007 Jun 2008 Oct 2008 Nov 2008 Dec 2008
• ensuring accurate temperature Average Average (N=1033) (N=810) (N=751) (N=908)
measurement upon arrival to the
post-anesthesia care unit.
Mental Health Services – the impact of this work was assessed results
Adult Units: SK3900 / by monitoring the length of stay • The length of stay decreased by
SK4800 and SK4700 & Child / and the patient/family response to about 0.5 days from 2007 to 2008.
Adolescent: SK3700 two satisfaction survey statements: I
participated in planning my discharge and
Developing pathways for
I received helpful education regarding my
individualized care
diagnosis and treatment.
staff in mental Health services
developed pathways to individualize
care for each patient based on his or her
diagnosis. pathways involve: Satisfaction Survey Percent Saying Percent Saying
• rounding on each shift on patients Statement Agree/Strongly Agree – Agree/Strongly Agree –
First Quarter 2008 Fourth Quarter 2008
• working with patients to meet
daily goals I participated in planning my
• education to teach patients discharge (for child/adolescent) 74% 90%
about their condition how to I received helpful education (for adult) 73% 78%
manage symptoms.
I am satisfied with the overall quality of
care and services (for child/adolescent) 84% 92%
I am satisfied with the overall quality
of care and services (for adult) 84% 90%
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17. Sister Kenny® Rehabilitation
Institute – W2300
Using care navigation to
improve outcomes
sister Kenny rehabilitation institute
implemented the care navigation
role in July 2008. the role is filled
by licensed registered rehabilitation
nurses, who are ideally positioned to
help individuals affected by chronic
illness physical disability adapt to
their disabilities, achieve their greatest
potential and work toward productive,
independent lives.
care navigators help patients
achieve goals that are necessary to Float Pool the study analyzed three 8-hour shifts
transition successfully from the acute and two 12-hour shifts (total of 217
comparing Assignment Difficulty
rehabilitation setting to home, while shifts) in medical/surgical, orthopaedic,
Among Unit Staff and Float pool Staff
helping the facility meet or exceed spine, neurology, cardiovascular and
the Float pool has more than 170
quality care outcome benchmarks. they critical care patient care units. data was
employees who serve more than 30
coordinate resources and services and collected on patient difficulty (acuity,
different departments at abbott
collaborate with the interdisciplinary patient flow, volume and “other”).
northwestern. this flexible workforce
rehabilitation team to ensure that the although there was a tendency for
is critical to the hospital’s success.
patient’s needs are met in the most Float pool nurses to receive more
in 2008, the Float pool focused on
effective manner. difficult patient assignments, this was
ways to increase staff satisfaction and
engagement and decrease turnover. not statistically significant. Because of
care navigation helps to achieve high study limitations, including the study
a key issue is ensuring that patient
levels of patient safety, coordination of size and the way in which the data was
care assignments are fair and equitable
care along a health continuum, patient collected and analyzed, funding is being
for all. in response to concerns raised
satisfaction, regulatory compliance and sought to repeat the study using a larger
by Float pool staff, a quantitative
efficient use of resources. the result is sample size, separate analysis per shift
study (the first of its kind in nursing
improved quality of care and patient and separate analysis of medical/surgical
literature) was done to compare
outcomes. and critical care data.
assignments between unit staff and
Float pool staff.
Comparison of the Difficulty
Between Float RN Assignments and Unit RN Assignments
2008
20
18 15
16
14
14
Difficulty
12
10
8
6
4
2
0
Float Staff RN Unit Staff RN
Note: Difficulty = Acuity + Flow + Volume + Other
NuRSI Ng dE PA RtM E Nt 15

18. Outpatient
enhancing the patient experience
through care continuity Overall Quality of Care and Services
nurses in the ambulatory surgery 90%
100%
center (asc) provide care and 78%
73% 71% 75%
continuous evaluation for outpatients 80% 69% 71% 67% 68%
61% 64%
undergoing procedures that require 60%
% Excellent
60%
local anesthesia, intravenous
sedation or general anesthesia. 40%
nursing assignments are structured to
support care continuity throughout 20%
a patient’s visit. For example, the
0%
asc peri-operative nurse performs a
Jan 08
Feb 08
Mar 08
Apr 08
May 08
Jun 08
Jul 08
Aug 08
Sep 08
Oct 08
Nov 08
Dec 08
pre-operative assessment and is able to
develop a rapport with each patient. at
this assessment, integrative therapies
may be initiated, such as music therapy
or televised relaxation instruction. the patients are randomly selected to receive a patient satisfaction survey at home
asc operating room nurse meets the after discharge. in 2008, 70 percent of patients rated the overall quality of care and
patient before the procedure and cares service as excellent. asc scores on the question “How would you rate the overall
for him or her during the procedure. quality of care and services?,” exceeded the allina goal every month.
after surgery, most patients return to
the same peri-operative nurse for care
until discharge.
Bariatric Center templates as the national template. staff post-operative bariatric surgical patients.
earning national recognition for also participated in a national workgroup Based on the findings of this review,
care pathways that created guidelines for care of the it was agreed to exempt the bariatric
in 2008, Bariatric center staff focused bariatric patient that will be used by new surgery patient population from the
on achieving re-designation as a centers trying to obtain the initial center policy on using Gcs and scd together
surgical review corporation Bariatric of excellence designation and for those on the post-operative nursing unit.
surgery center of excellence. not that are updating current pathways.
only did the Bariatric center receive
the designation—it also has received Assessing Skin integrity risk
national recognition for the care a skin integrity prevalence and
pathways it developed as part of the incidence survey showed that bariatric
re-designation process. the Bariatric surgical patients developed areas of
center pathways articulate the patient pressure when graduated compression
experience from initial seminar visit stockings (Gcs) with sequential
through the surgical experience and compression devices (scd) are used
lifelong follow-up. pathways addressed together. But patients who are morbidly
patient education, consent, radiology, obese also have a significant risk of
wound management, pain management, deep vein thrombosis, especially when
anesthesia, peri-operative care and subjected to the surgical positioning and
more. when the survey was completed abdominal pressure that occurs with
in september 2008, the surveyors asked laparoscopic surgery. a review of skin
to use the Bariatric center’s pathway integrity issues was conducted on 100
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19. ED/CDART Patient Flow Indicators—Time Intervals in Minutes
improving patient Flow and wait
times Jan-08 Dec-08
the emergency department total
visits increased from 46,218 in 2007 Arrival to Admit/Discharge 199.2 183.3
to 47,052 in 2008. improvements in Arrival to Admission 261.2 265.2
2008 have focused on patient flow and Arrival to eD Bed 27.2 16.1
patient satisfaction
Arrival to Discharge 169.4 157
eD Bed to Assigned rn 5.6 5.3
each month department leaders
and staff review the patient flow eD Bed to Assigned MD / np 19.3 16.3
indicators, identify barriers and take
steps to improve the flow through the
department. several time intervals are
tracked—these results are total minutes
from one interval to the next and show How long did you wait before being taken to the treatment area?
significant improvement in times during
2008. arrival to admission has many 100%
100%
variables, including hospital census/
bed availability, and creates the greatest 80%
Responses Indicating
69% 64%
challenge in patient flow.
No Waiting Time
60%
60% 56% 56%
48% 44%
the patient satisfaction survey question 40%
38% 37%
33%
40%
regarding wait times also shows
significant improvement. By december 20%
2008, 60 percent of patients reported
0%
no wait time from arrival to being taken
Jan 08
Feb 08
Oct 08
Mar 08
Apr 08
May 08
Jun 08
Jul 08
Aug 08
Sep 08
Nov 08
Dec 08
to treatment area:
Clinical Decision and Rapid Treatment (CDART) the numbers below show improvement
reducing length of Stay in the length of time patients are in
cdart is a 23-hour observation unit that sees a wide variety of patients, including cdart. total patient count is up
those needing extended observation for chest pain monitoring and testing, pain slightly but the total observation hours
management prior to surgeries and other patients needing stabilization or extended are down by 2,244 hours from 2007
time before being safe to be sent home. to 2008.
in 2008, cdart has focused on decreasing the length of stay. steps taken include: 2007 2008
• implementing the treatment plan immediately upon arrival total patients 3331 3,340
• getting consultations promptly total observation Hours 50,730 48,486
• educating the patient and family about the purpose of CDART and what they
should expect in the unit.
the cdart nurses work closely with
both the ed physicians and hospitalists
to provide the best and most efficient
experience possible for patients.
NuRSI Ng dE PA RtM E Nt 17

20. Mental Health Services
Outpatient Mental Health Clinic
enhancing Services
this outpatient mental health clinic is
staffed by a multidisciplinary team that
includes two registered nurses and four
nurse practitioners. the clinic moved
from the medical Office Building
to wasie 6th floor to provide an
environment better suited for patients
needing outpatient follow-up care. in
collaboration with the womencare
community, the outpatient clinic
was set up as a second location for
the post-partum depression program.
a transitions program was created to
assist people in making a successful ANW Adult Partial Hospital Program - 2008
transition from inpatient care or the
intensive therapy received in the Qtr 01 Qtr 02 Qtr 03 Qtr 04
partial hospitalization program to the
community. My therapists answered my questions so that I could 69% 55% 74% 80%
understand the answers
Mental Health Services Partial My therapists treated me with courtesy and respect 72% 62% 74% 73%
Hospital Program The staff provided helpful education regarding my 51% 46% 57% 59%
improving participant Attendance diagnosis and treatment
the adult partial program worked to Groups were helpful to me 58% 50% 66% 64%
improve program attendance. the top
My therapists listened to my concerns and opinions 69% 55% 74% 80%
three reasons for missing program days
were identified as illness/headache, other My nurses answered questions so I could understand 53% 43% 52% 57%
appointments and being tired/exhausted. the answers
improvement plans included: My nurses treated me with courtesy and respect 59% 48% 63% 66%
• educating patients on program rules My nurses listened to my concerns and opinions 50% 44% 55% 53%
and expectations for attendance and
participation
• assessing patients’ understanding of
the program and their individualized
treatment plans
Mental Health Services Assessment & Referral
• teaching the most effective ways of
coping and integrating skills learned identifying opportunities for improvement
into daily life. a tracking tool was developed that accurately captures all calls, emergency
department patient assessments, direct admissions, the number of patients declined
compliance in program attendance for admission, and reasons for patient diversion to other hospitals or programs. this
improved from 82.2 percent in march has helped to identify opportunities for future improvement projects including:
2008 to 89.4 percent in december • decrease the number of patients declined for admissions
2008. patient satisfaction scores also • increase the number of providers
improved. the table below shows
• increase communication from admitting source to inpatient units
the percentage of “strongly agree”
responses. • improve collaboration in care delivery to meet the patients’ needs.
18 O u t CO ME S R E P O Rt 2 0 0 9

21. Abbott Northwestern’s achievement. additionally, the Electroconvulsive
Infectious Disease Clinic initial work-up (a repeat ua) for an Therapy (ECT)
abnormal test was significantly more
improving renal Health Among improving patient education
likely to be completed after guideline
people with HiV Materials
implementation.
recently, the increased risk for chronic electroconvulsive therapy (ect)
kidney disease for people with Hiv educational materials for patients
practice changes occurred among
has come to the forefront. a nurse-led and families were improved through
the physicians, nursing, social work,
evidence-based practice improvement development of a video with up-to-
and dietary staff, which resulted
project was successfully implemented date information about ect. an
in improved renal health care for
with the multidisciplinary team. allina-wide educational teaching
individuals with Hiv. identification
this project had two components: sheet was developed to compliment
and involvement of key stakeholders
implementing agency-specific renal the video so that patients/families
was imperative for success. Ongoing
care guidelines by care providers and have current information about
reinvention includes development of
initiating renal and general health choosing this treatment option. all
a clear follow-up protocol to manage
education by supporting clinical staff. patients receive this information
abnormal renal screening tests and
before starting the treatment program.
continued data analysis to sustain the
Overall, after implementing the
practice changes.
guidelines, there was statistically
significant improvement in the
proportion of urinalyses (ua) and
estimated glomerular filtration rate
(eGFr) completion for patients during
their initial clinic visit (ua p < .001,
eGFr p =.002) and for those requiring
yearly (ua p < .001, eGFr p < .001)
or twice yearly (ua p < .001, eGFr p
< .001) renal testing. the rate of renal
health education was 60.7 percent,
which was less than the anticipated
rate of success. However, close analysis
revealed partial implementation
NuRSI Ng dE PA RtM E Nt 19

22. OB Homecare to questions about overall satisfaction and recommending OB Homecare to others,
increasing patient Satisfaction Scores post-partum patient satisfaction scores increased from 2007 to 2008. “excellent”
OB Homecare nurses make a special responses for overall quality increased by 6.8 percent; “definitely Yes” responses for
effort to encourage patients to recommending OB Homecare to family and friends increased by 8.1 percent.
provide feedback on their nursing
care and the services they receive
from OB Homecare. this, combined Postpartum Patient Satisfaction
with workflow changes to improve 100%
continuity of care, is believed to have 87%
79%
contributed to increases in patient 80%
66% 73%
satisfaction scores. Overall Quality of Care
(% Excellent)
60%
staff nurses explain to patients how Would you recommend
important it is to them to receive 40% OBHC (% of Yes)
their feedback. they also add their
initials at the bottom of the survey 20%
form before handing it out at the end
of their visit. in comparing responses 0%
2007 2008
Minnesota Perinatal Physicians
enhancing care through nursing
coordination
a fetal surgery/intervention program
that serves patients throughout the
upper midwest has highlighted the need
for registered nurse care coordination for
patients with complex pregnancies.
the midwest Fetal care center was
developed through collaboration with
minnesota perinatal physicans, pediatric
surgical associations, and children’s
Hospitals and clinics of minnesota. rn
care coordinators assist patients with
transportation needs and resources within
the twin cities area. they have been vital in addition to improving care would result in more convenient
to program development in areas such as: coordination for fetal therapy patients, services for patients and enhanced care
• patient education materials the perinatal clinic at abbott continuity and were able to incorporate
• community resources northwestern made it possible for testing into an already busy workflow.
patients to have any fetal testing done
• order set development
at the clinic site instead of at the
• outreach maternal assessment center, which
• staff development is located in a separate building on
campus. nurses recognized that this
• monthly care planning meetings
• care continuity from diagnosis
through delivery.
20 O u t CO ME S R E P O Rt 2 0 0 9